Individual provider Active NPI

Shola Philip Akinfiresoye, DNP, FNP-BC

  • Family Nurse Practitioner
  • Duncanville, TX
National Provider Identifier
1104339373
Registry record updated Jul 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP134810 Issued in TX
Practice address
609 S Main St
Duncanville, TX 75116-4713
Phone
(682) 472-2607
NPI assigned
Nov 10, 2017
Last updated
Jul 10, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X AP134810 TX
Family Nurse Practitioner 363LF0000X AP134810 TX Primary

Addresses

Primary practice location

609 S Main St
Duncanville, TX 75116-4713

Mailing address

2024 Limestone Dr
Grand Prairie, TX 75052-2693
Phone (682) 472-2607

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20201103002434 TX Practitioner - Nurse Practitioner 9234462953 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP134810TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
GLC Wellness Center Texas LLC CurrentSince Jan 4, 2023 Accepting new patients
Golden Life Wellness Center DFW LLC Family Medicine PastSince Jul 9, 2025 Accepting new patients

Locations

4801 S Cooper St
Ste 401
Arlington, TX 76017
Phone (817) 813-7100

777 E Wheatland Rd
Ste 106
Duncanville, TX 75116
Phone (702) 587-8106

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1510272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752105600000",
    "number": "1104339373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2024 LIMESTONE DR",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750522693",
            "telephone_number": "682-472-2607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 S MAIN ST",
            "city": "DUNCANVILLE",
            "state": "TX",
            "postal_code": "751164713",
            "telephone_number": "682-472-2607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AKINFIRESOYE",
        "first_name": "SHOLA",
        "middle_name": "PHILIP",
        "credential": "DNP, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-10",
        "last_updated": "2025-07-10",
        "certification_date": "2025-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "AP134810",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP134810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duncanville, TX

Sources for this page

Verify at the official NPI Registry.