Provider Demographics
NPI:1609609387
Name:ADEBISI, MORAYO FADEKEMI (NP)
Entity type:Individual
Prefix:
First Name:MORAYO
Middle Name:FADEKEMI
Last Name:ADEBISI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MORAYO
Other - Middle Name:FADEKEMI
Other - Last Name:OLAOFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5750 NORTHWEST PKWY STE 111
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3468
Mailing Address - Country:US
Mailing Address - Phone:210-348-4040
Mailing Address - Fax:
Practice Address - Street 1:15420 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-1106
Practice Address - Country:US
Practice Address - Phone:210-767-3870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154470363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner