Omotayo Theresa Gbengaojo, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

1110419 Issued in TX

Practice address

1475 Heritage Pkwy Ste 209
Mansfield, TX 76063-2740

Phone

(817) 523-8812

NPI assigned

Feb 20, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, CO2 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 2

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Rehoboth Mental Health and Psychiatry PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Mansfield, TX
  • NPI 1053156331
  Medicare reassignment NPD Authorized official
• Holistic Health and Psychiatry

  • Family Nurse Practitioner
  • Arlington, TX
  • NPI 1649870783

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  CO, Psychiatric/Mental Health, TX

  Medicare reassignment NPD

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

{
    "created_epoch": "1676851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748217600000",
    "number": "1972201895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1312 LAWNVIEW DR",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751261308",
            "telephone_number": "903-922-5944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1475 HERITAGE PKWY STE 209",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760632740",
            "telephone_number": "817-523-8812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GBENGAOJO",
        "first_name": "OMOTAYO",
        "middle_name": "THERESA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-20",
        "last_updated": "2025-05-26",
        "certification_date": "2025-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1110419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Promise Garrett
• Abbie McKelvey Garrison, MA, BCBA, LBA
• Kimberly Ann Garza, PMHNP
• Patricia Jane Gatlin, LPC, LMFT
• Olatunde Gbadebo
• Uzoma Ben Gbulie, MBBS
• Gencae House of Care of Texas LLC
• Gencare Services
• David Bryce George, LMSW
• Nancy Georgekutty, M.D.

• Psychiatric/Mental Health Nurse Practitioner in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2025; 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.