Individual provider Active NPI

Latifat Adelekan-Adeogun

  • Psychiatric/Mental Health Nurse Practitioner
  • Mansfield, TX
National Provider Identifier
1689124125
Registry record updated Jun 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP132188 Issued in TX
Practice address
404 E Broad St Ste 600
Mansfield, TX 76063-1743
Phone
(319) 600-6693
NPI assigned
Oct 7, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP132188 TX Primary

Addresses

Primary practice location

404 E Broad St Ste 600
Mansfield, TX 76063-1743

Mailing address

404 E Broad St Ste 600
Mansfield, TX 76063-1743
Phone (319) 600-6693

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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 1

Enrollment IDStateProvider typePAC IDDetails
I20170210000462 TX Practitioner - Nurse Practitioner 6305129644 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Anderson Cherokee Community Enrichment ServicesGroup PAC ID 4284718107, 11 clinicians

Practice addresses (Care Compare)

1011 College Ave
Jacksonville, TX 75766-3307
Phone (903) 589-9000

700 Highlander Blvd
Suite 500
Arlington, TX 76015-4326
Phone (214) 760-6895

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Duncanville Mental Health Services PastSince Mar 19, 2018 Accepting new patients

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1475798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654041600000",
    "number": "1689124125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 E BROAD ST STE 600",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760631743",
            "telephone_number": "319-600-6693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 E BROAD ST STE 600",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760631743",
            "telephone_number": "319-600-6693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADELEKAN-ADEOGUN",
        "first_name": "LATIFAT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-07",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP132188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, TX

Sources for this page

Verify at the official NPI Registry.