Provider Demographics
NPI:1285457663
Name:OSIDELE, IYABO KIKELOMO (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:IYABO
Middle Name:KIKELOMO
Last Name:OSIDELE
Suffix:
Gender:F
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 1:1200 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-1206
Mailing Address - Country:US
Mailing Address - Phone:346-286-2476
Mailing Address - Fax:
Practice Address - Street 1:1200 BAKER ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-1206
Practice Address - Country:US
Practice Address - Phone:346-286-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1179283363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health