Omotolu Olaitan Aje-Omokore, CNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Wichita, KS
NPI 1548699739 · NPPES record last updated Jun 16, 2022
Key facts
- NPI
- 1548699739
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- AP60590699 (WA)
- Practice address
- 753 N West St, Wichita, KS 67203
Wichita, KS 67226 - Phone
- (316) 685-5691
- NPI assigned
- Nov 7, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- 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 |
|---|---|---|---|---|
| I20200213000053 | NM | Practitioner - Nurse Practitioner | 4981913860 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP60590699 | WA | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blissful Minds LLC | Psychiatric/Mental Health | Current |
Accepting new patients |
| Promed Physican Services, P.a. | Past | Accepting new patients |
Locations
10409 Montgomery Pkwy NE
Ste 202B
Albuquerque, NM 87111
Phone (505) 910-4070
Interoperability endpoints
- oaje153811@direct.phs.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Health Clinical Nurse Specialist | 364SF0001X | 53-76179-091 | KS | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | AP60590699 | WA | Yes |
Addresses
Primary practice location
753 N West St, Wichita, KS 67203
Wichita, KS 67226
Mailing address
2801 N Rock Rd Apt 1508
Wichita, KS 67226-1185
Phone (316) 990-4126
Other providers in Wichita, KS
- Air City Emergency Physicians LLC
- Aircapitalcardiology, PA
- Airmd, LLC
- Aishwarya Abbareddy DMD LLC
- Rose Ndululu Aiyenowo
- Kristen Michelle Akers
- Scott Akers
- Esther Akidiva
- Samuel Akidiva
- Tayler Akin
All providers in Wichita, KS · Psychiatric/Mental Health Nurse Practitioner in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2022. 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.