Richard Nasiru Elelu

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

278312 Issued in AZ

Practice address

7125 East Cesar Chavez Boulevard
San Luis, AZ 85349-0376

Phone

(928) 627-8871

NPI assigned

Aug 9, 2022

Last updated

Aug 9, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1660003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1205564242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7125 EAST CESAR CHAVEZ BOULEVARD",
            "city": "SAN LUIS",
            "state": "AZ",
            "postal_code": "853490376",
            "telephone_number": "928-627-8871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7125 EAST CESAR CHAVEZ BOULEVARD",
            "city": "SAN LUIS",
            "state": "AZ",
            "postal_code": "853490376",
            "telephone_number": "928-627-8871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELELU",
        "first_name": "RICHARD",
        "middle_name": "NASIRU",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-09",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "278312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in San Luis, AZ
• Providers in San Luis, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.