Individual provider Active NPI

Stella Ajayi-Adediran, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Sugar Land, TX
National Provider Identifier
1063166809
Registry record updated May 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
202214096NP-PP Issued in OR
Practice address
11645 S Highway 6 # 1023
Sugar Land, TX 77498-1302
Phone
(832) 405-4402
Fax
(503) 549-9493
NPI assigned
Feb 10, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1070382 TX
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 202214096NP-PP OR Primary

Addresses

Primary practice location

11645 S Highway 6 # 1023
Sugar Land, TX 77498-1302

Mailing address

7615 Aimua CT
Houston, TX 77083-3741
Phone (713) 303-5698

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221207000282 OR Practitioner - Nurse Practitioner 7719937937 Reassigns benefits to 2 organizations
I20231030003596 TX Practitioner - Nurse Practitioner 7719937937

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2600 Ctr St NE
Salem, OR 97301-2669
Phone (503) 945-2800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
202214096NP-PPORMDPsychiatric/Mental Health Nurse Practitioner
1070382TXMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jalstad Ventures Incorporated Current Accepting new patients
DHS/Office of Financial Services Irs/Eopc/BMRC/Eotc/Osh/Osh-P CurrentSince Oct 25, 2022 Accepting new patients

Locations

2600 Center St NE
Salem, OR 97301
Phone (503) 945-2800

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1644451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748563200000",
    "number": "1063166809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7615 AIMUA CT",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770833741",
            "telephone_number": "713-303-5698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11645 S HIGHWAY 6 # 1023",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774981302",
            "telephone_number": "832-405-4402",
            "fax_number": "503-549-9493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AJAYI-ADEDIRAN",
        "first_name": "STELLA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-10",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1070382",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "202214096NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sugar Land, TX

Sources for this page

Verify at the official NPI Registry.