Jumoke Elizabeth Adedeji

Key facts

NPI

1225501158

Entity type

Individual (NPI type 1)

Primary specialty

Family Nurse Practitioner 363LF0000X

License

1113016 (TX)

Practice address

323 Chimney Rock Dr Apt 1128323
Tyler, TX 75703-4101

Phone

(903) 724-6624

NPI assigned

Jan 3, 2019

Sex

Female

Sole proprietor

No

Organizations & group practices 2

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.

• Berachah Nursing Care PLLC Family Nurse Practitioner · Desoto, TX · NPI 1598608648
  NPD Authorized official FAMILY
• Americare Medical Partners, PLLC Infectious Disease Physician · Lewisville, TX · NPI 1346651072
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 30, 2023.

{
    "created_epoch": "1546473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693353600000",
    "number": "1225501158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 CHIMNEY ROCK DR APT 1128323",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757034101",
            "telephone_number": "903-724-6624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 CHIMNEY ROCK DR APT 1128323",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757034101",
            "telephone_number": "903-724-6624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADEDEJI",
        "first_name": "JUMOKE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-03",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1113016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Tyler, TX · Family Nurse Practitioner in Texas