# KLE NURSE PRACTITIONER IN PSYCHIATRY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639996242
- **Authorized official:** KEMISOLA EBIETOMIYE (OWNER OF ENTITY)
- **Authorized official phone:** (347) 378-3144

## Contact information

- **Practice address:** 109 N 12TH ST STE 704, BROOKLYN, NY 11249-1002
- **Practice address phone:** (347) 378-3144
- **Practice address fax:** (469) 242-9827
- **Mailing address:** 548 WESTWOOD WAY DR, HASLET, TX 76052-3079
- **Mailing address phone:** (347) 378-3144
- **Mailing address fax:** (469) 242-9827

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/24/2024
- **Last updated:** 05/14/2025