Omowoleola Bakare
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · South Jordan, UT
NPI 1003766619 · NPPES record last updated Feb 26, 2026
Key facts
- NPI
- 1003766619
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 2025099576 (UT)
- Practice address
- 1654 W Reunion Ave Ste 10B
South Jordan, UT 84095-4676 - Phone
- (801) 349-2480
- NPI assigned
- Feb 2, 2026
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
9100 E Mineral Cir
Centennial, CO 80112-3401
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2025099576 | UT | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dynamic Psychiatry PLLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 2025099576 | UT | Yes |
Addresses
Primary practice location
1654 W Reunion Ave Ste 10B
South Jordan, UT 84095-4676
Mailing address
965 E 5290 S
Murray, UT 84117-6671
Other providers in South Jordan, UT
- Amritpal Badwalz
- Pamela Denise Bailey-Good
- Cody Tonga Bair
- Gregory A Baird
- Jonathan Thomas Baird
- Jennifer Ballard
- Bangerter Dental, LLC
- Emma Barcenas
- Gina Labrum Barfuss
- Chad Barksdale
All providers in South Jordan, UT · Psychiatric/Mental Health Nurse Practitioner in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.