Oluwagbemiga Odede, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

268009 Issued in AZ

Practice address

4111 E Valley Auto Dr Ste 201
Mesa, AZ 85206-4609

Phone

(470) 313-2572

NPI assigned

Dec 21, 2021

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1640044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1245990977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4111 E VALLEY AUTO DR STE 201",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4111 E VALLEY AUTO DR STE 201",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064609",
            "telephone_number": "470-313-2572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODEDE",
        "first_name": "OLUWAGBEMIGA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-21",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "268009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christian Ochoa, DDS
• Shannon Ochs, RN
• Thaddeo Consunji Oconer, MD
• Ocotillo Hospital and Surgical Services, LLC
• Ocotillo Sleep Solutions LLC
• Jill Odgren-Cole, N.D.
• Salim Otieno Odiero
• Harold Odutola, PA
• Odyssey Services Corp.
• Meredith Oehler, LPC

• Psychiatric/Mental Health Nurse Practitioner in Mesa, AZ
• Providers in Mesa, 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 Dec 21, 2021; 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.