Provider Demographics
NPI:1972301984
Name:ADENIJI, KHADIJAT TEMITOPE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KHADIJAT
Middle Name:TEMITOPE
Last Name:ADENIJI
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4180 THIELMAN LN STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4692
Mailing Address - Country:US
Mailing Address - Phone:320-281-3154
Mailing Address - Fax:
Practice Address - Street 1:4180 THIELMAN LN STE 100
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4692
Practice Address - Country:US
Practice Address - Phone:320-281-3145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13280363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health