Provider Demographics
NPI:1316333479
Name:OLOYEDE, OMOLOLA K (NP)
Entity type:Individual
Prefix:
First Name:OMOLOLA
Middle Name:K
Last Name:OLOYEDE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24044 CINCO VILLAGE CENTER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8433
Mailing Address - Country:US
Mailing Address - Phone:346-517-7874
Mailing Address - Fax:346-205-0499
Practice Address - Street 1:24044 CINCO VILLAGE CENTER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8433
Practice Address - Country:US
Practice Address - Phone:346-517-7874
Practice Address - Fax:346-205-0499
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY696905163W00000X
TXAP144755363LF0000X
TX144755363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily