Provider Demographics
NPI:1245708544
Name:ALLEN, MODUPE ADETUTU (FNP)
Entity type:Individual
Prefix:
First Name:MODUPE
Middle Name:ADETUTU
Last Name:ALLEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14007 SEA MYRTLE LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-2095
Mailing Address - Country:US
Mailing Address - Phone:281-701-9729
Mailing Address - Fax:
Practice Address - Street 1:14007 SEA MYRTLE LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-2095
Practice Address - Country:US
Practice Address - Phone:281-701-9729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF10181507207Q00000X
TXAP139893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine