Modupe Adesola

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

3010425 Issued in KY

Practice address

4301 Wilson St
Fort Sill, OK 73503-4472

Phone

(580) 558-8242

NPI assigned

Jul 7, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

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

Practice roles

Locations

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.

• Commonwealth of Kentucky

  • Multi-Specialty Clinic/Center
  • Louisville, KY
  • NPI 1114346467
  Medicare reassignment NPD
• Commonwealth of Kentucky

  • Skilled Nursing Facility
  • Radcliff, KY
  • NPI 1043686900
  NPD
• Pearl Medical Practice PLLC

  • Primary Care Clinic/Center
  • Louisville, KY
  • NPI 1669841631
  NPD (past)

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

{
    "created_epoch": "1467849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1184076770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1123 ABBEYWOOD RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402224401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 WILSON ST",
            "city": "FORT SILL",
            "state": "OK",
            "postal_code": "735034472",
            "telephone_number": "580-558-8242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADESOLA",
        "first_name": "MODUPE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-07",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3010425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ahmed Abou Elmagd, MD
• Silas Capuyan Abrenica, FNP
• Carlos A Aguilar, PTA
• Donald Matthew Aguilar, DC
• Ahc Reynolds-Ft Sill
• Ahc Reynolds-Ft Sill
• Ahc Reynolds-Ft Sill

• Nurse Practitioner in Fort Sill, OK
• Providers in Fort Sill, OK by specialty
• Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; 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.