Provider Demographics
NPI:1902339096
Name:LAWAL, RISIKAT IDOWU (NP-C, FNP)
Entity Type:Individual
Prefix:
First Name:RISIKAT
Middle Name:IDOWU
Last Name:LAWAL
Suffix:
Gender:F
Credentials:NP-C, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 ANNIE OAKLEY DR
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-5137
Mailing Address - Country:US
Mailing Address - Phone:469-685-9522
Mailing Address - Fax:
Practice Address - Street 1:1130 ANNIE OAKLEY DR
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409
Practice Address - Country:US
Practice Address - Phone:469-685-9522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133708363LF0000X, 363LP0808X
CO0001338363LP0808X
CA95020061363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily