Provider Demographics
NPI:1144713611
Name:OMOBA, ADEGBOYEGA (DNP, PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:ADEGBOYEGA
Middle Name:
Last Name:OMOBA
Suffix:
Gender:M
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 WISHING WELL CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-8255
Mailing Address - Country:US
Mailing Address - Phone:682-560-0666
Mailing Address - Fax:
Practice Address - Street 1:1141 WISHING WELL CT
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-8255
Practice Address - Country:US
Practice Address - Phone:682-560-0666
Practice Address - Fax:817-422-0781
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX840719163W00000X
COC-APN.0001960-C-NP363LP0808X
AZ2639996363LP0808X
TXAP137736363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse