Provider Demographics
NPI:1497645758
Name:FEYISOLA, OLORUNKEMI AJOKE
Entity type:Individual
Prefix:
First Name:OLORUNKEMI
Middle Name:AJOKE
Last Name:FEYISOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLORUNKEMI
Other - Middle Name:MESTURAH
Other - Last Name:KOTUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8827 MONTJOY PL
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-8003
Mailing Address - Country:US
Mailing Address - Phone:757-781-9991
Mailing Address - Fax:
Practice Address - Street 1:8827 MONTJOY PL # 8827
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-8003
Practice Address - Country:US
Practice Address - Phone:757-781-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR266292363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health