Elizabeth Oyewunmi Adeshola
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Mansfield, TX
NPI 1740950898 · NPPES record last updated Sep 19, 2021
Key facts
- NPI
- 1740950898
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 1049314 (TX)
- Practice address
- 3106 Willow Brook Dr
Mansfield, TX 76063-2075 - Phone
- (817) 723-0778
- NPI assigned
- Sep 19, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Community Intervention Associates Inc.
Practice addresses (Care Compare)
1773 W Saint Marys Rd
Suite 102
Tucson, AZ 85745-2654
Phone (520) 622-8357
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- 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 |
|---|---|---|---|---|
| I20221205002981 | AZ | Practitioner - Nurse Practitioner | 6901275411 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1049314 | TX | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Intervention Assciates, Inc | Current |
Accepting new patients | |
| Community Intervention Associates, Inc. | Single Specialty | Current |
Accepting new patients |
| Community Intervention Associates, Inc. | Single Specialty | Past | Accepting new patients |
Locations
32 Boulevard del Rey David
Nogales, AZ 85621
Phone (520) 281-9189
1516 S Ocotillo Ave
Parker, AZ 85344
Phone (928) 669-5319
2375 N Wyatt Dr
Ste 103
Tucson, AZ 85712
Phone (520) 622-8357
1773 W Saint Marys Rd
Ste 102
Tucson, AZ 85745
Phone (520) 622-8357
2851 S Avenue B
Bldg 4
Yuma, AZ 85364
Phone (928) 919-2436
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X | 1049314 | TX | Yes |
Addresses
Primary practice location
3106 Willow Brook Dr
Mansfield, TX 76063-2075
Mailing address
3106 Willow Brook Dr
Mansfield, TX 76063-2075
Phone (817) 723-0778
Other providers in Mansfield, TX
- Emmanuel Addo
- Adeyinka Adekanola
- Latifat Adelekan-Adeogun
- Anuoluwapo Ibironke Adelodun
- Adem Enterprises LLC
- Samuel Adeyi
- Oladunni Adeyosoye
- Adf Homecare Services LLC
- Adonai Care LLC
- Uchenna Aduba
All providers in Mansfield, TX · Psychiatric/Mental Health Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2021. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.