Johnson Komolafe, NP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Springfield, VA
NPI 1174540504 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1174540504
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- R123830 (MD)
- Practice address
- 7011 Calamo St
#105
Springfield, VA 22150 - Phone
- (301) 670-4250
- NPI assigned
- Jul 15, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R123830 | MD | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Benjamin a. Adewale MD PC | Past |
Accepting new patients | |
| Benjamin Adewale MD PC | Past | Accepting new patients | |
| Crawford Consulting and Mental Health Services, Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | R123830 | MD | Yes |
Addresses
Primary practice location
7011 Calamo St
#105
Springfield, VA 22150
Mailing address
PO Box 8057
Alexandria, VA 22306-8057
Other providers in Springfield, VA
- Henry Donald Knox
- Lorena Yuvette Knox
- Stephanie Koch
- Emily Anne Kohut
- Meihannah Y Kolb
- Lauren Koontz
- Kora Analysis, LLC
- Maria Korossy
- Kapil Kotadia
- Mai Koussa
All providers in Springfield, VA · Psychiatric/Mental Health Nurse Practitioner in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.