Provider Demographics
NPI:1811708100
Name:KUTI, BUKOLA OLUWASHOLA
Entity type:Individual
Prefix:
First Name:BUKOLA
Middle Name:OLUWASHOLA
Last Name:KUTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BUKOLA
Other - Middle Name:OLUWASHOLA
Other - Last Name:AWOSANYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4265 CORN SILK LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-2213
Mailing Address - Country:US
Mailing Address - Phone:651-230-1900
Mailing Address - Fax:
Practice Address - Street 1:4265 CORN SILK LN
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-2213
Practice Address - Country:US
Practice Address - Phone:651-230-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 101YM0800X
TX1077716363LP0808X
MN12493363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1077716OtherAPRN-CNP