Individual provider Active NPI

Mulikat Bolanle Ilesanmi

  • Psychiatric/Mental Health Nurse Practitioner
  • Mansfield, TX
National Provider Identifier
1790124980
Registry record updated Feb 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
363LP0808X Issued in TX
Practice address
1409 Old Rocksprings Pass
Mansfield, TX 76063-2219
Phone
(443) 713-9223
NPI assigned
Jun 20, 2013
Last updated
Feb 5, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2026

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 363LP0808X TX Primary

Addresses

Primary practice location

1409 Old Rocksprings Pass
Mansfield, TX 76063-2219

Mailing address

1409 Old Rocksprings Pass
Mansfield, TX 76063-2219
Phone (443) 713-9223

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
I20260319003451 TX Practitioner - Nurse Practitioner 3678057411 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
4L-a Clinic and Consultants, IncGroup PAC ID 0941685788, 2 clinicians

Practice addresses (Care Compare)

102 E Danieldale Rd
Suite 101
Duncanville, TX 75137-4028
Phone (469) 868-6250

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
363LP0808XTXMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
4L-a Clinic and Consultants Inc Psychiatric/Mental Health CurrentSince Mar 1, 2026 Accepting new patients
Franbo Professional Services Psychiatric/Mental Health Past Accepting new patients

Locations

102 E Danieldale Rd
Ste 101
Duncanville, TX 75137
Phone (469) 868-6250

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1371686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770249600000",
    "number": "1790124980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 OLD ROCKSPRINGS PASS",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760632219",
            "telephone_number": "443-713-9223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 OLD ROCKSPRINGS PASS",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760632219",
            "telephone_number": "443-713-9223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILESANMI",
        "first_name": "MULIKAT",
        "middle_name": "BOLANLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-20",
        "last_updated": "2026-02-05",
        "certification_date": "2026-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "363LP0808X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, TX

Sources for this page

Verify at the official NPI Registry.