Adeline Memorial Medical Group PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

ADELINE MEMORIAL MEDICAL GROUP PLLC

Practice address

3200 Avenue I
Rosenberg, TX 77471-3630

Phone

(832) 344-3650

NPI assigned

Feb 11, 2021

Last updated

Aug 6, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Funmilola O Odutayo, FNPNPI 1679761845

Title

Provider

Phone

(832) 344-3650

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Funmilola O Odutayo

  • Family Nurse Practitioner
  • Rosenberg, TX
  • NPI 1679761845
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1613001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754438400000",
    "number": "1760075667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 AVENUE I",
            "city": "ROSENBERG",
            "state": "TX",
            "postal_code": "774713630",
            "telephone_number": "832-344-3650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 AVENUE I",
            "city": "ROSENBERG",
            "state": "TX",
            "postal_code": "774713630",
            "telephone_number": "832-344-3650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6515 Corporate Dr Ste D1",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770363426",
            "country_code": "US",
            "telephone_number": "713-981-5166",
            "fax_number": "713-981-5288",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADELINE MEMORIAL MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-11",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A",
        "authorized_official_last_name": "ODUTAYO",
        "authorized_official_first_name": "FUNMILOLA",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "832-344-3650",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Rosenberg, TX
• Providers in Rosenberg, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.