Provider Demographics
NPI:1073335436
Name:POPOOLA, KAFAYAT OLATEJU (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KAFAYAT
Middle Name:OLATEJU
Last Name:POPOOLA
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5510
Mailing Address - Country:US
Mailing Address - Phone:346-235-7127
Mailing Address - Fax:
Practice Address - Street 1:207 N UNION AVE STE E
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-3068
Practice Address - Country:US
Practice Address - Phone:575-363-3189
Practice Address - Fax:575-363-3188
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1057732363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health