Provider Demographics
NPI:1396328308
Name:YOADE, OLUBUKOLA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:OLUBUKOLA
Middle Name:
Last Name:YOADE
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 1:1910 PACIFIC AVE STE 2000
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4540
Mailing Address - Country:US
Mailing Address - Phone:469-754-9744
Mailing Address - Fax:469-936-7552
Practice Address - Street 1:1910 PACIFIC AVE STE 2000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4540
Practice Address - Country:US
Practice Address - Phone:469-754-9744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1040950363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXXY6903985OtherDATA 2000 WAIVER
TX1040950OtherLICENSE
TX1040950OtherLICENSE