Provider Demographics
NPI:1487122073
Name:OKEYEMI, STANLEY IMOLEAYO (PMHNP)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:IMOLEAYO
Last Name:OKEYEMI
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:STANLEY
Other - Middle Name:OKIEMUTE
Other - Last Name:ORUMAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:703 RIVERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2272
Mailing Address - Country:US
Mailing Address - Phone:469-245-4643
Mailing Address - Fax:
Practice Address - Street 1:4645 SAMUELL BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-6826
Practice Address - Country:US
Practice Address - Phone:214-275-7393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139584363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health