Active NPI
Adesuwa Taiye Omorodion
- Licensed Vocational Nurse
- Grand Prairie, TX
National Provider Identifier
1508422296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- 302634
- Practice address
- 2650 S Forum Dr Apt 17201
Grand Prairie, TX 75052-7049 - Phone
- (817) 673-6067
- NPI assigned
- May 17, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 302634 | TX | Primary |
Addresses
Primary practice location
2650 S Forum Dr Apt 17201
Grand Prairie, TX 75052-7049
Mailing address
2650 S Forum Dr Apt 17201
Grand Prairie, TX 75052-7049
Phone (817) 673-6067
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 302634 | TX | MD | Licensed Vocational Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558051200000",
"number": "1508422296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2650 S FORUM DR APT 17201",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750527049",
"telephone_number": "817-673-6067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2650 S FORUM DR APT 17201",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750527049",
"telephone_number": "817-673-6067"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OMORODION",
"first_name": "ADESUWA",
"middle_name": "TAIYE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-17",
"last_updated": "2019-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "TX",
"license": "302634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Prairie, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.