Provider Demographics
NPI:1063606804
Name:PEDRO, KARIMOT ADENIKE (NP-C)
Entity type:Individual
Prefix:MS
First Name:KARIMOT
Middle Name:ADENIKE
Last Name:PEDRO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19015 CREST COVE DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3391
Mailing Address - Country:US
Mailing Address - Phone:832-455-4624
Mailing Address - Fax:
Practice Address - Street 1:19015 CREST COVE DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-3391
Practice Address - Country:US
Practice Address - Phone:832-455-4624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX662417363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX363LA2200XOtherTAXONOMY
TX26-3081025OtherIRS
TX26-3081025OtherIRS
TXTXB102731OtherGROUP PTAN
TX363LA2200XOtherTAXONOMY
TX262708YMN0OtherIND PTAN