Provider Demographics
NPI:1861986986
Name:ADEBUSOYE, STELLA O (DNP,PMHNP,FNP,APRNBC)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:O
Last Name:ADEBUSOYE
Suffix:
Gender:F
Credentials:DNP,PMHNP,FNP,APRNBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 CASTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-0340
Mailing Address - Country:US
Mailing Address - Phone:240-645-3390
Mailing Address - Fax:
Practice Address - Street 1:2121 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201
Practice Address - Country:US
Practice Address - Phone:214-331-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX814209163WP0808X
TXAP136863363LF0000X
COCAPN0001350363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health