Taiwo Okubanjo, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP139920 Issued in TX

Practice address

4601 Seneca Dr
Fort Worth, TX 76137-6141

Phone

(682) 556-1274

NPI assigned

Mar 12, 2019

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

Enrolled in TX

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

Credentials

Nurse Practitioner

State licenses

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.

• Graceland Psychiatric and Neuromodulation Center PLLC

  • Psychiatry Physician
  • San Antonio, TX
  • NPI 1518548262
  Medicare reassignment NPD

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

{
    "created_epoch": "1552348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552348800000",
    "number": "1285192963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 SENECA DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761376141",
            "telephone_number": "682-556-1274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 SENECA DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761376141",
            "telephone_number": "682-556-1274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKUBANJO",
        "first_name": "TAIWO",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-12",
        "last_updated": "2019-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP139920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tinuade Olukemi Okoro, MD
• Emmanuel Okechukwu Okoroafor
• Ehiamen Tolulope Okoruwa, MD
• Robin Okpara
• Shawn Okechukwu Okpara, MD
• Taiwo Olabode
• Tolani Adeyemi Olabode
• Olubunmi C Oladosu
• Gbemisola D Olajide, FNP
• Omolara A Olajide, MBBS

• Family Nurse Practitioner in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 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.