# OMOKOREDE FATILE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1275256992
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 0024195935 | VA | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 125356 | WV | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 405486 | NY | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 71017850A | IN | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | R214086 | MD | Yes |
| 364SP0809X | Adult Psychiatric/Mental Health Clinical Nurse Specialist | R214086 | MD | — |

## Other

- **Enumeration date:** 09/20/2022
- **Last updated:** 06/04/2026