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NPI Code Detail

MEDICARE: OMOSALEWA ADEGBOYEGA

MEDICARE: OMOSALEWA ADEGBOYEGA
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
1363LF0000XFamily Nurse PractitionerAP08414LA

General Provider Information

NPI Number : 1730553421
Entity Type Code : Individual
Provider Name (Legal Business Name) : OMOSALEWA ADEGBOYEGA
Provider Business Mailing Address
First Line : 1666 E BERT KOUNS INDUSTRIAL LOOP STE 105
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-5718
Country : US
Telephone Number : 318-212-3520
Fax Number : 318-212-3525
Provider Business Practice Location Address
First Line : 1666 E BERT KOUNS INDUSTRIAL LOOP STE 105
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-5718
Country : US
Telephone Number : 318-212-3520
Fax Number : 318-212-3525
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2015
Last Update Date : 05/08/2026

Similar Medicare Providers

1902838105 — PAUL STUART WILSON MD
Practice Location Address:
1666 E BERT KOUNS INDUSTRIAL LOOP STE 105
SHREVEPORT, LA
71105-5718
Practice Phone: 318-212-3520
Practice Fax: 318-212-3525
1164603478 — PRAKASH GIDDALURI MD, MPH
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1033390398 — CARSON ELIZABETH SHETLEY PA-C
Practice Location Address:
1666 E BERT KOUNS INDUSTRIAL LOOP STE 105
SHREVEPORT, LA
71105-5718
Practice Phone: 318-212-3520
Practice Fax: 318-212-3525
1740735323 — MS. AMBROSIA A JEFFERY FNP-C
Practice Location Address:
1666 E BERT KOUN LOOP STE 105
SHREVEPORT, LA
71105-5718
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Practice Fax: 318-212-3525
1750925822 — NICOLE ANNALISE BARNARD PA-C
Practice Location Address:
1666 E BERT KOUNS INDUSTRIAL LOOP STE 105
SHREVEPORT, LA
71105-5718
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Practice Fax:
1760092282 — STEPHANIE DENNISON
Practice Location Address:
1666 E BERT KOUNS INDUSTRIAL LOOP STE 105
SHREVEPORT, LA
71105-5718
Practice Phone: 318-212-3520
Practice Fax:

Directions to “ OMOSALEWA ADEGBOYEGA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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