Provider Demographics
NPI:1710781042
Name:OYEBANJI, OMOTADE (PMHNP)
Entity type:Individual
Prefix:
First Name:OMOTADE
Middle Name:
Last Name:OYEBANJI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 INDIGO CT
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-2511
Mailing Address - Country:US
Mailing Address - Phone:832-818-2154
Mailing Address - Fax:
Practice Address - Street 1:3300 S FM 1788
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-2601
Practice Address - Country:US
Practice Address - Phone:432-561-5915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1194523363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health