Mofoluwasho Adenekan, FNP
Individual provider Active NPI Family Nurse Practitioner · Knoxville, TN
NPI 1407460207 · NPPES record last updated Sep 1, 2020
Key facts
- NPI
- 1407460207
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 2020067608 (TN)
- Practice address
- 6100 Stratford Park Blvd
Knoxville, TN 37912-2109 - Phone
- (865) 237-9291
- NPI assigned
- Aug 31, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230509003176 | TX | Practitioner - Nurse Practitioner | 0244642627 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2020067608 | TN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Wound Care of North Texas PLLC | Current |
Accepting new patients | |
| GLC Wellness Center Texas LLC | Current |
Accepting new patients | |
| Golden Life Wellness Center DFW LLC | Family | Past |
Accepting new patients |
Locations
13154 Coit Rd
Ste 102D
Dallas, TX 75240
Phone (469) 726-2287
1251 E Red Bird Ln
Ste A
Dallas, TX 75241
Phone (214) 377-0608
777 E Wheatland Rd
Ste 106
Duncanville, TX 75116
Phone (702) 587-8106
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | 2020067608 | TN | |
| Family Nurse Practitioner | 363LF0000X | 2020067608 | TN | Yes |
Addresses
Primary practice location
6100 Stratford Park Blvd
Knoxville, TN 37912-2109
Mailing address
6100 Stratford Park Blvd
Knoxville, TN 37912-2109
Phone (865) 237-9291
Other providers in Knoxville, TN
- Cynthia Denise Addison
- Caryn T Addonizio
- Steven Addonizio
- Addus Healthcare (South Carolina), Inc.
- Lauren Cathleen Ade
- Adh Ventures LLC
- Danny Adkins
- Koda Adkins
- Michial A Adkins
- Paige Adkins
All providers in Knoxville, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 1, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.