Provider Demographics
NPI:1427827989
Name:SHOWPATHWAY MENTAL AND WELLNESS SERVICES PLLC
Entity type:Organization
Organization Name:SHOWPATHWAY MENTAL AND WELLNESS SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:YETUNDE
Authorized Official - Middle Name:
Authorized Official - Last Name:FADEYIBI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN/ PMHNP
Authorized Official - Phone:406-296-6469
Mailing Address - Street 1:5900 BALCONES DR # 17066
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4257
Mailing Address - Country:US
Mailing Address - Phone:406-296-6469
Mailing Address - Fax:832-862-3414
Practice Address - Street 1:5900 BALCONES DR # 17066
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4257
Practice Address - Country:US
Practice Address - Phone:406-296-6469
Practice Address - Fax:832-862-3414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty