Provider Demographics
NPI:1366060204
Name:OKIEIMEN, ADEBISI (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ADEBISI
Middle Name:
Last Name:OKIEIMEN
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 1:540 CHAPEL DR
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-3490
Mailing Address - Country:US
Mailing Address - Phone:281-975-7760
Mailing Address - Fax:
Practice Address - Street 1:540 CHAPEL DR
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-3490
Practice Address - Country:US
Practice Address - Phone:281-975-7760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX882665163WP0808X
TX1007038363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health