Provider Demographics
NPI:1891514832
Name:OLUKITIBI, ANGELA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:OLUKITIBI
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 1:410 NW 11TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5416
Mailing Address - Country:US
Mailing Address - Phone:214-218-6302
Mailing Address - Fax:
Practice Address - Street 1:410 NW 11TH ST STE 107
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5416
Practice Address - Country:US
Practice Address - Phone:214-218-6302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX959507363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health