Provider Demographics
NPI:1730559717
Name:KAZZIM, OLUBUNMI OLUFUNKE (FNP - C)
Entity type:Individual
Prefix:MRS
First Name:OLUBUNMI
Middle Name:OLUFUNKE
Last Name:KAZZIM
Suffix:
Gender:F
Credentials:FNP - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14520 OLD KATY RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1048
Mailing Address - Country:US
Mailing Address - Phone:832-847-1527
Mailing Address - Fax:281-558-3432
Practice Address - Street 1:14520 OLD KATY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1048
Practice Address - Country:US
Practice Address - Phone:832-847-1527
Practice Address - Fax:281-558-3432
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily