Provider Demographics
NPI:1386380608
Name:ASEKUN, SIMISOLA MORAYO
Entity type:Individual
Prefix:
First Name:SIMISOLA
Middle Name:MORAYO
Last Name:ASEKUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1678 CARDINAL RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6308
Mailing Address - Country:US
Mailing Address - Phone:817-903-3353
Mailing Address - Fax:
Practice Address - Street 1:607 E ABRAM ST STE 14
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:817-903-3353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1076135363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty