Abimbola Datonye Iketubosin, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

221449 Issued in AZ

Practice address

501 W Ray Rd Ste 4
Chandler, AZ 85225-7284

Phone

(602) 654-3802

Fax

(800) 682-1416

NPI assigned

Feb 14, 2018

Last updated

Sep 18, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, AZ, TX3 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 3

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clinica Sierra VistaGroup PAC ID 3870407505, shared by 31 NPIs, 180 clinicians

Gila River Health Care CorporationGroup PAC ID 0648174185, 245 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Huhu Kam Memorial Hospital Hospital, Sacaton, AZ, CCN 031308

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: abimola.iketubosin.1@33227.direct.athenahealth.com
• Direct secure messaging: aiketubosin21321@clinicasierravista.direct-ci.com

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.

• Gila River Health Care Corporation

  dba Komatke Health Center

  • Critical Access Hospital
  • Laveen, AZ
  • NPI 1376538231

  TX

  Medicare reassignment Care Compare group NPD
• Corner Health Medical Group P a

  • Family Nurse Practitioner
  • Phoenix, AZ
  • NPI 1205689171
  Medicare reassignment NPD
• Privia Medical Group Arizona, LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1760441141
  Medicare reassignment NPD
• Clinica Sierra Vista

  dba East Bakersfield Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Bakersfield, CA
  • NPI 1861494338
  Medicare reassignment NPD
• Clinicas de Salud del Pueblo, Inc

  dba Innercare

  • Federally Qualified Health Center (FQHC)
  • El Centro, CA
  • NPI 1346313889
  Medicare reassignment NPD
• Da-Bee LLC

  • Family Nurse Practitioner
  • Buckeye, AZ
  • NPI 1124724885
  NPD Authorized official
• Gila River Health Care

  dba Thwajik Ke Outpatient Behavioral Health Services

  • Community/Behavioral Health Agency
  • Laveen, AZ
  • NPI 1598021495
  NPD
• Gila River Health Care Corporation

  dba AK-Chin Clinic

  • Rural Acute Care Hospital
  • Maricopa, AZ
  • NPI 1386633915
  NPD
• Privia Medical Group Arizona, LLC

  • Neurology Physician
  • Phoenix, AZ
  • NPI 1245876705
  NPD
• Clinica Sierra Vista

  dba Lamont Pharmacy

  • Community/Retail Pharmacy
  • Lamont, CA
  • NPI 1275161325
  NPD
• Clinica Sierra Vista

  dba Frazier Mountain Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Lebec, CA
  • NPI 1457353831
  NPD
• Clinicas de Salud del Pueblo Inc.

  dba InnerCare Pharmacy

  • Community/Retail Pharmacy
  • El Centro, CA
  • NPI 1962045872
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Gila River Health Care Corporation

  dba Hu Hu Kam Memorial Hospital

  • Critical Access Hospital
  • Sacaton, AZ
  • NPI 1225023179
  Care Compare affiliation
• Gila River Health Care Corporation

  dba HuHuKam Memorial Hospital - EMS

  • Ambulance
  • Sacaton, AZ
  • NPI 1851441075

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1518566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789689600000",
    "number": "1356841514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 96770",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850726770",
            "telephone_number": "602-581-6076",
            "fax_number": "602-263-1619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 W RAY RD STE 4",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852257284",
            "telephone_number": "602-654-3802",
            "fax_number": "800-682-1416"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4212 N 16th St",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850165319",
            "country_code": "US",
            "telephone_number": "602-263-1200",
            "fax_number": "602-263-1619",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IKETUBOSIN",
        "first_name": "ABIMBOLA",
        "middle_name": "DATONYE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-14",
        "last_updated": "2026-09-18",
        "certification_date": "2026-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "F08180855",
            "primary": false
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "AZ",
            "license": "221449",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "221449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bukari Abdi Igal
• Ignite Physical Therapy and Wellness
• Ignite Physical Therapy PLC
• Michael N. Igwe, M.D
• James Adeyemo Ijiwoye, D.C.
• Daisy Ili
• Michael Iliescu
• Immaculate Heart of Mary Family Health Center
• Moses Ohiguerhei Imohi, M.D.
• Imove Health LLC

• Family Nurse Practitioner in Chandler, AZ
• Providers in Chandler, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.