Ibukun Odutola

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

810773 Issued in NV

Practice address

3345 N Windsong Dr
Prescott Valley, AZ 86314-2283

Phone

(928) 445-5211

NPI assigned

Jul 14, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NV, AZ, CA3 enrollments

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 3

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

West Yavapai Guidance Clinic IncGroup PAC ID 3375524358, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Master of Science, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ibukun.odutolarn.p1@direct.lifewell.nextgenshare.com
• Direct secure messaging: ibukun.odutola@521794035712004.direct.elationemr.com

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.

• Victory Health Solution LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Mesa, AZ
  • NPI 1912515305

  NV

  Medicare reassignment NPD Authorized official
• West Yavapai Guidance Clinic, Inc

  dba Polara Health

  • Psychiatric Hospital
  • Prescott, AZ
  • NPI 1952550071
  Medicare reassignment Care Compare group NPD
• I Am Wellness Az LLC

  • Adult Medicine Physician
  • Chandler, AZ
  • NPI 1184354532
  Medicare reassignment NPD
• Albion Medical Group of Nevada, PC

  dba CareMore Medical Group of Nevada (Worku), PC

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1578840724
  Medicare reassignment NPD
• Albion Medical Partners of California West P C

  dba CareMore Health Medical Partners West, PC

  • Internal Medicine Physician
  • Cerritos, CA
  • NPI 1073110607
  Medicare reassignment NPD
• Sud Specialty Group - Ca

  dba Rula Health

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Santa Clara, CA
  • NPI 1972138238
  Medicare reassignment
• West Yavapai Guidance Clinic

  dba Polara Health

  • Clinic/Center
  • Camp Verde, AZ
  • NPI 1538878186
  NPD
• West Yavapai Guidance Clinic

  dba Hillside CD Residential

  • Substance Abuse Rehabilitation Facility
  • Prescott, AZ
  • NPI 1750335311
  NPD
• Nevada Internal Medicine Ctr-Burt MD LTD

  dba Nevada Internal Medicine Center

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1982734133
  NPD
• Community Bridges, Inc.

  dba Central City Addiction Recovery Center

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1649426909
  NPD (past)
• Community Bridges, Inc.

  dba CCARC Crisis

  • Nursing Care Agency
  • Phoenix, AZ
  • NPI 1891288049
  NPD (past)
• I Am Wellness Az LLC

  dba Success Care

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1376372078
  NPD (past)

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

{
    "created_epoch": "1594684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788220800000",
    "number": "1801404074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3345 N WINDSONG DR",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142283",
            "telephone_number": "928-445-5211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3345 N WINDSONG DR",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142283",
            "telephone_number": "928-445-5211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODUTOLA",
        "first_name": "IBUKUN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-14",
        "last_updated": "2026-09-01",
        "certification_date": "2026-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NV",
            "license": "810773",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "244759",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northern Arizona Orthosports Physical Therapy Inc
• Northland Cares
• Michael Lee Nothdurft, RPH
• Nuanced Therapy LLC
• Nurses Network Incorporated (Nurses Network by Quality Home Health Care)
• Elisa Olivier-Nielsen, RDN
• Maren Michele Olsen, PHARMD
• Kizmi Levens Olson, P.T.
• Stacy Olson
• One Psychological Services

• Psychiatric/Mental Health Nurse Practitioner in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.