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NPI Code Detail

MEDICARE: OMAYEMI C OMAGHOMI FNP-C

MEDICARE: OMAYEMI C OMAGHOMI FNP-C
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
1163WM0705XMedical-Surgical Registered Nurse842389TX
2363LF0000XFamily Nurse PractitionerAP134355TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1842389OTHERTXTEXAS BOARD OF NURSING
2AP134355OTHERTXTEXAS BON

General Provider Information

NPI Number : 1750810974
Entity Type Code : Individual
Provider Name (Legal Business Name) : OMAYEMI C OMAGHOMI FNP-C
Provider Business Mailing Address
First Line : PO BOX 650859
Second Line : DEPT 710
City : DALLAS
State : TX
Zip : 75265
Country : US
Telephone Number : 409-772-2222
Fax Number :
Provider Business Practice Location Address
First Line : 6416 BROADWAY ST
Second Line :
City : GALVESTON
State : TX
Zip : 77551-1033
Country : US
Telephone Number : 409-772-3695
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2017
Last Update Date : 02/28/2023

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