Shola Adewunmi, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP61063594 Issued in WA

Practice address

6115 Burden Blvd Ste D
Pasco, WA 99301-0010

Phone

(509) 488-5256

Fax

(509) 488-9939

NPI assigned

Aug 2, 2019

Last updated

Jan 29, 2024By 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

Enrolled in GA

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

• Lifesource of North Carolina

  dba LifeSource of Georgia

  • General Practice Physician
  • Rome, GA
  • NPI 1962940817
  Medicare reassignment

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

{
    "created_epoch": "1564704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1073168449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 E COLUMBIA ST",
            "city": "OTHELLO",
            "state": "WA",
            "postal_code": "993441846",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6115 BURDEN BLVD STE D",
            "city": "PASCO",
            "state": "WA",
            "postal_code": "993010010",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1515 E Columbia St",
            "address_purpose": "LOCATION",
            "city": "Othello",
            "state": "WA",
            "postal_code": "993441846",
            "country_code": "US",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1051 Columbia Ave",
            "address_purpose": "LOCATION",
            "city": "Connell",
            "state": "WA",
            "postal_code": "993268702",
            "country_code": "US",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 Government Rd",
            "address_purpose": "LOCATION",
            "city": "Mattawa",
            "state": "WA",
            "postal_code": "993495120",
            "country_code": "US",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14723 London Ln",
            "address_purpose": "LOCATION",
            "city": "Bowie",
            "state": "MD",
            "postal_code": "207152548",
            "country_code": "US",
            "telephone_number": "404-902-9180",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1345 Redmond Cir NW",
            "address_purpose": "LOCATION",
            "city": "Rome",
            "state": "GA",
            "postal_code": "301651307",
            "country_code": "US",
            "telephone_number": "910-742-9243",
            "fax_number": "888-746-1787",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6115 Burden Blvd Ste D",
            "address_purpose": "LOCATION",
            "city": "Pasco",
            "state": "WA",
            "postal_code": "993010010",
            "country_code": "US",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADEWUNMI",
        "first_name": "SHOLA",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-02",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "AC002778",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61063594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• A Plus Interpreters
• Melissa Abel, RN
• Accident Care Chiropractic and Massage of Pasco, PC
• Accident Chiropractic of Pasco (Accident Chiropractic)
• Eli A. Adamian, MD
• Advantagepoint Health Alliance - Northwest, LLC
• Joy Aerts
• Katavera Ahlgreen
• Dheeraj Ahuja, MD
• David Ainscow, B.A.B.S.

• Psychiatric/Mental Health Nurse Practitioner in Pasco, WA
• Providers in Pasco, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.