Provider Demographics
NPI:1750794822
Name:ISIAKA, KAMALDEEN (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:KAMALDEEN
Middle Name:
Last Name:ISIAKA
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W NORTHWEST HWY STE 240
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8107
Mailing Address - Country:US
Mailing Address - Phone:713-884-0208
Mailing Address - Fax:214-382-0881
Practice Address - Street 1:1701 W NORTHWEST HWY STE 240
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8107
Practice Address - Country:US
Practice Address - Phone:214-385-2808
Practice Address - Fax:214-382-0881
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088172363LF0000X
TX12108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor