Provider Demographics
NPI:1871485359
Name:FOWOPE, DAVID OLATUNBOSUN (PMHNP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:OLATUNBOSUN
Last Name:FOWOPE
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:ENIOLA-DAVID
Other - Middle Name:OLATUNBOSUN
Other - Last Name:FOWOPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:D FOWOPE PMHNP-BC
Mailing Address - Street 1:7304 COMBINE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-9542
Mailing Address - Country:US
Mailing Address - Phone:765-209-8193
Mailing Address - Fax:
Practice Address - Street 1:9165 OTIS AVE STE 164
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-2312
Practice Address - Country:US
Practice Address - Phone:765-209-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71016847A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty