Individual provider Active NPI

Omobolanle Aanuoluwa Oluwunmi, AGNP-C, PMHNP-BC

  • Gerontology Nurse Practitioner
  • Katy, TX
National Provider Identifier
1801314430
Registry record updated Jul 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
AP135016 Issued in TX
Practice address
3542 Heartland Key Lane
Katy, TX 77494
Phone
(281) 704-8923
NPI assigned
Sep 4, 2017
Last updated
Jul 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X AP135016 TX Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP135016 TX

Addresses

Primary practice location

3542 Heartland Key Lane
Katy, TX 77494

Mailing address

3542 Heartland Key LN
Katy, TX 77494-1408
Phone (281) 704-8923

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
I20180828000310 TX Practitioner - Nurse Practitioner 0749539583 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Vpa of Texas PLLC Multi-Specialty CurrentSince Mar 1, 2021 Accepting new patients
Vpa of Texas PLLC Multi-Specialty CurrentSince Mar 1, 2021 Accepting new patients
Signify Health Medical Associates, PLLC Multi-Specialty CurrentSince Jun 1, 2020 Accepting new patients

Locations

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

4545 Fuller Dr
Ste 325
Irving, TX 75038
Phone (972) 870-5511

Interoperability endpoints

  • Direct secure messaging: omobolanle.oluwunmi.p1@direct.alegiscare.nextgenshare.com
  • Direct secure messaging: omobolanle.oluwunmi.p2@direct.alegiscare.nextgenshare.com

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, 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": "1504483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1801314430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3542 HEARTLAND KEY LN",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774941408",
            "telephone_number": "281-704-8923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3542 HEARTLAND KEY LANE",
            "city": "KATY",
            "state": "TX",
            "postal_code": "77494",
            "telephone_number": "281-704-8923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLUWUNMI",
        "first_name": "OMOBOLANLE",
        "middle_name": "AANUOLUWA",
        "credential": "AGNP-C, PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-04",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "AP135016",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP135016",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Katy, TX

Sources for this page

Verify at the official NPI Registry.