Provider Demographics
NPI:1063766848
Name:LAYENI, OMOLARA (PA-C)
Entity type:Individual
Prefix:
First Name:OMOLARA
Middle Name:
Last Name:LAYENI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9628 REA RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6697
Mailing Address - Country:US
Mailing Address - Phone:704-542-5072
Mailing Address - Fax:
Practice Address - Street 1:9101 PINEVILLE MATTHEWS RD STE C4
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-8840
Practice Address - Country:US
Practice Address - Phone:980-202-7920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001005636363A00000X, 363A00000X
MEPA1795363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant