Provider Demographics
NPI:1518362862
Name:ADEPETUN, RUTH DAMILOLA (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:DAMILOLA
Last Name:ADEPETUN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MISS
Other - First Name:RUTH
Other - Middle Name:DAMILOLA
Other - Last Name:AHOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:311 WILLIAMSON RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5967
Mailing Address - Country:US
Mailing Address - Phone:704-360-3049
Mailing Address - Fax:704-973-9588
Practice Address - Street 1:311 WILLIAMSON RD STE 103
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5967
Practice Address - Country:US
Practice Address - Phone:704-360-3049
Practice Address - Fax:704-973-9588
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60931406363LP0808X
NC5009234363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health