Provider Demographics
NPI:1326897349
Name:ADU, AKINOLA B
Entity type:Individual
Prefix:MR
First Name:AKINOLA
Middle Name:B
Last Name:ADU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 REMINGTON RANCH RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5722
Mailing Address - Country:US
Mailing Address - Phone:817-455-7261
Mailing Address - Fax:
Practice Address - Street 1:607 E ABRAM ST STE 9
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-1206
Practice Address - Country:US
Practice Address - Phone:817-987-1079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1160241363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health