Individual provider Active NPI

Mutiat Temitope Olawunmi, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Richmond, TX
National Provider Identifier
1316604861
Registry record updated Oct 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
404116 Issued in NY
Practice address
26711 Beacon Lodge Lane
Richmond, TX 77407-2277
Phone
(281) 258-5344
NPI assigned
Nov 18, 2021
Last updated
Oct 20, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 20, 2025

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

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 202208555 OR
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 404116 NY Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 0103592 CO
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 68094 NM
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 61530158 WA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1060110 TX
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95023833 CA
Adult Psychiatric/Mental Health Clinical Nurse Specialist 364SP0809X 0103592 CO

Addresses

Primary practice location

26711 Beacon Lodge Lane
Richmond, TX 77407-2277

Mailing address

26711 Beacon Lodge LN
Richmond, TX 77406-0157
Phone (281) 258-5344

Other practice location 1

1225 NE 2nd Ave
Portland, OR 97232-2003
Phone (503) 944-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, TX, OR, CO, NY, WY, WA, AK, NE9 enrollments
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 9

Enrollment IDStateProvider typePAC IDDetails
I20230405000204 NM Practitioner - Nurse Practitioner 2062887060 Reassigns benefits to 4 organizations
I20231005000367 TX Practitioner - Nurse Practitioner 2062887060 Reassigns benefits to 2 organizations
I20241119004062 OR Practitioner - Nurse Practitioner 2062887060 Reassigns benefits to 3 organizations
I20260310002640 CO Practitioner - Nurse Practitioner 2062887060 Reassigns benefits to 1 organization
I20260311000268 NY Practitioner - Nurse Practitioner 2062887060 Reassigns benefits to 1 organization
I20260318002478 WY Practitioner - Nurse Practitioner 2062887060 Reassigns benefits to 1 organization
I20260331001398 WA Practitioner - Nurse Practitioner 2062887060 Reassigns benefits to 1 organization
I20260602000667 AK Practitioner - Nurse Practitioner 2062887060 Reassigns benefits to 1 organization
I20260625004578 NE Practitioner - Nurse Practitioner 2062887060 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

66 E Flagler St
Miami, FL 33130-1807

721 Depot Dr
Anchorage, AK 99501-1615

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95023833CAMDPsychiatric/Mental Health Nurse Practitioner
404116NYMDPsychiatric/Mental Health Nurse Practitioner
202208555ORMDPsychiatric/Mental Health Nurse Practitioner
61530158WAMDPsychiatric/Mental Health Nurse Practitioner
0103592COMDAdult Psychiatric/Mental Health Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Musally Healthcare, LLC Single Specialty CurrentSince Jul 9, 2025 Accepting new patients
Grow Healthcare Group PA Single Specialty CurrentSince Feb 6, 2026 Accepting new patients
Lifeline Medical Center Single Specialty CurrentSince Aug 22, 2023 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Oct 20, 2025 Accepting new patients
Legacy Emanuel Hospital & Health Center Single Specialty CurrentSince Oct 20, 2025 Accepting new patients
Mental Health Specialty Group PA Single Specialty CurrentSince Sep 1, 2025 Accepting new patients
Legacy Emanuel Hospital & Health Center Single Specialty Current Accepting new patients
Bello USA LLC Single Specialty CurrentSince Oct 1, 2024 Accepting new patients

Locations

3321 Candelaria Rd NE
Ste 250
Albuquerque, NM 87107
Phone (505) 358-0803

500 Marquette Ave NW
Albuquerque, NM 87102
Phone (505) 429-5750

6565 Americas Pkwy NE
Ste 200
Albuquerque, NM 87110
Phone (404) 408-5442

1915 NE Stucki Ave
Ste 400
Hillsboro, OR 97006
Phone (844) 408-0014

1925 NE Stucki Ave
Ste 150
Hillsboro, OR 97006

1225 NE 2nd Ave
Portland, OR 97232
Phone (503) 413-5051

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

4500 Mercantile Plaza Dr
Ste 300
Ft Worth, TX 76137
Phone (469) 688-9501

Networks

  • UT PPO

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20067/brand/1/csg/1/fhir/r4

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1637193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760918400000",
    "number": "1316604861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26711 BEACON LODGE LN",
            "city": "RICHMOND",
            "state": "TX",
            "postal_code": "774060157",
            "telephone_number": "281-258-5344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26711 BEACON LODGE LANE",
            "city": "RICHMOND",
            "state": "TX",
            "postal_code": "774072277",
            "telephone_number": "281-258-5344"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1225 NE 2nd Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972322003",
            "country_code": "US",
            "telephone_number": "503-944-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLAWUNMI",
        "first_name": "MUTIAT",
        "middle_name": "TEMITOPE",
        "name_prefix": "Dr.",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-18",
        "last_updated": "2025-10-20",
        "certification_date": "2025-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "202208555",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "404116",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CO",
            "license": "0103592",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NM",
            "license": "68094",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "61530158",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1060110",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95023833",
            "primary": false
        },
        {
            "code": "364SP0809X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": "CO",
            "license": "0103592",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, TX

Sources for this page

Verify at the official NPI Registry.