# FO NURSE PRACTITIONER IN PSYCHIATRY PLLC

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

## Provider details

- **NPI number:** 1801627476
- **Authorized official:** FADEKEMI SULIAT OLUDE (CEO)
- **Authorized official phone:** (972) 449-7614

## Contact information

- **Practice address:** 246-09 139TH AVENUE, ROSEDALE, NY 11422
- **Practice address phone:** (972) 449-7614
- **Practice address fax:** (972) 947-5275
- **Mailing address:** 3449 AVA DR, MIDLOTHIAN, TX 76065-2274
- **Mailing address phone:** (972) 449-7614
- **Mailing address fax:** (972) 947-5275

## 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:** 08/13/2024
- **Last updated:** 08/14/2024