Provider Demographics
NPI:1346920477
Name:REMI-JOHNSON, OLUMIDE T (PMHNP-BC, FNP-C)
Entity type:Individual
Prefix:
First Name:OLUMIDE
Middle Name:T
Last Name:REMI-JOHNSON
Suffix:
Gender:M
Credentials:PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 OAKTON DR
Mailing Address - Street 2:
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004-2489
Mailing Address - Country:US
Mailing Address - Phone:973-462-1868
Mailing Address - Fax:
Practice Address - Street 1:411 N WASHINGTON AVE STE 5200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1778
Practice Address - Country:US
Practice Address - Phone:855-204-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1151066363LP0808X, 363LF0000X
NJ26NJ14883000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily