MEDICARE: MODUPEOLA FALUBI PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2019072717	MO
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	53-79373-051	KS

General Provider Information

NPI Number	:	1689290017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MODUPEOLA FALUBI PMHNP

Provider Business Mailing Address
First Line	:	5741 N BEAMAN AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-3293
Country	:	US
Telephone Number	:	816-456-2557
Fax Number	:

Provider Business Practice Location Address
First Line	:	5741 N BEAMAN AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-3293
Country	:	US
Telephone Number	:	816-456-2557
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	02/25/2026

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