Provider Demographics
NPI:1962167718
Name:AWONIYI, OLUBUKOLA A (RN, PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:OLUBUKOLA
Middle Name:A
Last Name:AWONIYI
Suffix:
Gender:M
Credentials:RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20710 BARRINGTON MEADOW TRCE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2267
Mailing Address - Country:US
Mailing Address - Phone:718-755-2049
Mailing Address - Fax:
Practice Address - Street 1:20710 BARRINGTON MEADOW TRCE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2267
Practice Address - Country:US
Practice Address - Phone:718-755-2049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403285363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2021101871OtherANCC CERTIFICATION