Adebola Adekoya, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Elkridge, MD
NPI 1114613809 · NPPES record last updated Apr 14, 2023
Key facts
- NPI
- 1114613809
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- R259579 (MD)
- Practice address
- 7220 Discovery Dr
Elkridge, MD 21075-7414 - Phone
- (312) 590-6969
- NPI assigned
- Apr 14, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240426001092 | NY | Practitioner - Nurse Practitioner | 7810337607 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R259579 | MD | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MVHS Inc | Current |
Accepting new patients | |
| MVHS Inc | Current |
Accepting new patients |
Locations
1656 Champlin Ave
New Hartford, NY 13413
Phone (315) 624-6222
1676 Sunset Ave
Utica, NY 13502
Phone (315) 624-5567
2215 Genesee St
Rm 105
Utica, NY 13501
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | R259579 | MD | Yes |
Addresses
Primary practice location
7220 Discovery Dr
Elkridge, MD 21075-7414
Mailing address
18502 Sweet Autumn Dr Apt 101
Gaithersburg, MD 20879-5353
Phone (312) 590-6969
Other providers in Elkridge, MD
- Yasmeen Ibrahim Abou-Sayed
- Absolute Communikty Services, LLC
- Abundance Home Care
- Active Day MD, Inc.
- Liliane Addidigue
- Funke Suliyat Adepiti
- Oluwafunke Oluwafu Aderemi
- Flourish Adetoye
- Oladapo A Adewuya
- Damilola Adeyale
All providers in Elkridge, MD · Psychiatric/Mental Health Nurse Practitioner in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.