Provider Demographics
NPI:1174070767
Name:AJALA, HELEN OLASUNMADE (NP)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:OLASUNMADE
Last Name:AJALA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 ST JOHN ST.
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501
Mailing Address - Country:US
Mailing Address - Phone:337-470-3460
Mailing Address - Fax:
Practice Address - Street 1:406 ST JOHN ST.
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-8882
Practice Address - Country:US
Practice Address - Phone:337-470-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08982363LP0808X
LAAP093218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health