Individual provider Active NPI

Kikelomo Omolola Dawotola, FNP

  • Family Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1093285504
Registry record updated Nov 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP139838 Issued in TX
Practice address
3330 S Lancaster Rd
Dallas, TX 75216-4531
Phone
(214) 743-1200
NPI assigned
Nov 27, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP139838 TX Primary

Addresses

Primary practice location

3330 S Lancaster Rd
Dallas, TX 75216-4531

Mailing address

1008 Angie LN
Desoto, TX 75115-3870
Phone (214) 281-9480

Other practice location 1

1008 Angie Ln
DeSoto, TX 75115-3870
Phone (214) 281-9480

Other identifiers 1

IdentifierTypeStateIssuer
AP139838OtherTXTEXAS BOARD OF NURSING

Other names 1

  • Ms. Kikelomo Omolola Apantaku Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CT, WA, IA, AZ, NE6 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 6

Enrollment IDStateProvider typePAC IDDetails
I20230201000034 TX Practitioner - Nurse Practitioner 0547631483 Reassigns benefits to 1 organization
I20250226001228 CT Practitioner - Nurse Practitioner 0547631483 Reassigns benefits to 1 organization
I20250228003470 WA Practitioner - Nurse Practitioner 0547631483 Reassigns benefits to 1 organization
I20250303001916 IA Practitioner - Nurse Practitioner 0547631483 Reassigns benefits to 1 organization
I20250624003969 AZ Practitioner - Nurse Practitioner 0547631483 Reassigns benefits to 1 organization
I20260625004688 NE Practitioner - Nurse Practitioner 0547631483 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dallas County Mental Health and Mental Retardation CenterGroup PAC ID 2062308091, 68 clinicians

Practice addresses (Care Compare)

3330 S Lancaster Rd
Metrocare Services
Dallas, TX 75216-4531
Phone (214) 743-6159

Merit-based Incentive Payment System (MIPS)

Final score
75.31 of 100Reported as group
Quality
56.91
Promoting interoperability
52
Improvement activities
40
Cost
84.11

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP139838TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dallas County Mental Health & Mental Retardation Center CurrentSince Jan 23, 2023 Accepting new patients
Grow Healthcare Group PA CurrentSince Jan 21, 2025 Accepting new patients

Locations

4600 E Washington St
Ste 300
Phoenix, AZ 85034
Phone (602) 638-1872

100 Pearl St
Fl 14
Hartford, CT 06103
Phone (860) 421-6636

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

699 Walnut St
Ste 4
Des Moines, IA 50309
Phone (515) 278-9920

3330 S Lancaster Rd
Dallas, TX 75216
Phone (214) 371-0474

1345 River Bend Dr
Ste 200
Dallas, TX 75247
Phone (214) 743-1201

1455 NW Leary Way
Ste 400
Seattle, WA 98107
Phone (206) 202-8506

Organizations & group practices 2

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": "1543276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762732800000",
    "number": "1093285504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 ANGIE LN",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751153870",
            "telephone_number": "214-281-9480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 S LANCASTER RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752164531",
            "telephone_number": "214-743-1200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1008 Angie Ln",
            "address_purpose": "LOCATION",
            "city": "DeSoto",
            "state": "TX",
            "postal_code": "751153870",
            "country_code": "US",
            "telephone_number": "214-281-9480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAWOTOLA",
        "first_name": "KIKELOMO",
        "middle_name": "OMOLOLA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-27",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP139838",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS BOARD OF NURSING",
            "identifier": "AP139838",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIKELOMO",
            "last_name": "APANTAKU",
            "middle_name": "OMOLOLA",
            "prefix": "MS.",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.