Individual
KEYAMO M OMOKURU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNP, PMHNP-BC
Contact information
Practice address
928 W COMMERCE ST, SAN ANTONIO, TX 78207-4444
(210) 261-1250
(210) 434-0716
Mailing address
6800 PARK TEN BLVD STE 200S, SAN ANTONIO, TX 78213-4293
(210) 261-1000
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
PN 19805
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP141260
TX
Other
Enumeration date
01/25/2010
Last updated
05/02/2019
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