Olawale Nurudeen Moyosore

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

262277 Issued in AZ

Practice address

500 Highway 89 North
Prescott, AZ 86313

Phone

(928) 445-4860

NPI assigned

May 24, 2021

Last updated

Jan 28, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643328000000",
    "number": "1063087849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "181 WHIPPLE ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011705",
            "telephone_number": "480-719-6554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 HIGHWAY 89 NORTH",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "86313",
            "telephone_number": "928-445-4860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOYOSORE",
        "first_name": "OLAWALE",
        "middle_name": "NURUDEEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-24",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "262277",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP143491",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Soundos K Moualla, MD
• Mountain Oak Charter School
• Mountain Oak School Inc.
• Mountain View Mental Health and Primary Care
• Heather Moutvic
• Teresa Ann Mueller-Sanchez, MS CCC-SLP
• Marcia S Mulcahey, NP
• Gerald L Muncy Jr., MD
• Sarah Munigle, M.C
• Erik Pedro Munoz, PHYSICIAN ASSISTANT

• Psychiatric/Mental Health Nurse Practitioner in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.