Provider Demographics
NPI:1134689078
Name:ADEOYE, ABIBAT ADENIKE
Entity type:Individual
Prefix:
First Name:ABIBAT
Middle Name:ADENIKE
Last Name:ADEOYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 HAVANA DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5676
Mailing Address - Country:US
Mailing Address - Phone:214-909-7763
Mailing Address - Fax:
Practice Address - Street 1:10539 E KINETIC DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-8043
Practice Address - Country:US
Practice Address - Phone:469-466-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM72660363LP0808X
TX1099241363LP0808X
AZ289319363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health