Individual
OMOTAYO THERESA GBENGAOJO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1475 HERITAGE PKWY STE 209, MANSFIELD, TX 76063-2740
(817) 523-8812
Mailing address
1312 LAWNVIEW DR, FORNEY, TX 75126-1308
(903) 922-5944
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1110419
TX
Other
Enumeration date
02/20/2023
Last updated
05/26/2025
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