MICHAEL G OMOTOLA (NPI# 1124505615) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124505615 |
| Entity Type | Individual |
| Full Name | MICHAEL G OMOTOLA |
| Credential | PA-C |
| Practice Address |
2520 W I 20 Grand Prairie TX 75052-7280 |
| Mailing Address |
417 W 20th St Unit 11386 Norfolk VA 23517-1287 |
| Practice Telephone | 5123633257 |
| Mailing Telephone | 5123633257 |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2018-07-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2520 W I 20 |
| City | GRAND PRAIRIE |
| State | TX |
| Zip Code | 75052-7280 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447575162 | Angela Layton Hyden | Physician Assistant | 2520 W I 20, Grand Prairie, TX 75052-7280 | 2010-04-06 |
| 1114416245 | Meha Patel | Physician Assistant | 2520 W I 20, Grand Prairie, TX 75052-7280 | 2018-05-03 |
| 1043717747 | Michael Owusu Agyemang | Nurse Practitioner | 2520 W I 20, Grand Prairie, TX 75052-7280 | 2018-04-09 |
| 1316245558 | Elvis Ngyia | Registered Nurse | 2520 W I 20, Grand Prairie, TX 75052-7280 | 2011-03-12 |
| 1588981450 | Avneet Gill | Family Medicine | 2520 W I 20, Grand Prairie, TX 75052-7280 | 2010-04-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487265542 | Beyond Home Health Care LLC | Registered Nurse | 3531 Pecos Way, Grand Prairie, TX 75052 | 2020-08-12 |
| 1497370332 | Michael Cooper | Dentist | 3154 South Hwy 161 Ste 640, Grand Prairie, TX 75052 | 2020-06-16 |
| 1043835788 | Amanda Azubike | Licensed Practical Nurse | 4593 Mt Laurel Dr, Grand Prairie, TX 75052 | 2020-06-09 |
| 1457992844 | Epic West Family Dnetistry Pllc | Dentist | 3166 Sh 161, Ste 190, Grand Prairie, TX 75052 | 2019-10-07 |
| 1033777487 | National Vision Inc | Optometrist | 3166 South Highway 161, Suite 160, Grand Prairie, TX 75052 | 2019-05-31 |
| 1689136624 | Raushanah Taherrah Shareef-jefferson | Dental Hygienist | 831 Ridgecrest Rd, Grand Prairie, TX 75052 | 2019-04-01 |
| 1053812552 | Dfw Better Care Physicians, Pllc | Clinic/Center | 5204 Tx 360 #400, Grand Prairie, TX 75052 | 2018-02-21 |
| 1629586797 | Grand Prairie Marvel Dental Pllc | Clinic/Center | 5020 S Hwy 360, Suite 200, Grand Prairie, TX 75052 | 2018-01-11 |
| 1033626221 | Thad Taylor Iv Dds | Dentist | 3261 S. Carrier Pkwy., Grand Prairie, TX 75052 | 2018-01-09 |
| 1902312796 | Real Dental Pllc | Dentist | 1215 W. Pioneer Pkwy, Suite 130, Grand Prairie, TX 75052 | 2017-12-16 |
| Find all providers in zip 75052 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720686116 | Richard Magana | Physician Assistant | 1651 Ridgemar Dr, Grand Prairie, TX 75051-3340 | 2020-10-16 |
| 1447812565 | Jerusha Michal Lancaster | Physician Assistant | 5040 Stagecoach Way, Grand Prairie, TX 75052-2438 | 2019-06-29 |
| 1780156778 | Claire Kipp | Physician Assistant | 1515 Avenue S Ste 200, Grand Prairie, TX 75050-1263 | 2019-01-01 |
| 1699253336 | Courtney Ann Mutchler | Physician Assistant | 5203 Lake Ridge Pkwy, Grand Prairie, TX 75052-3006 | 2018-08-03 |
| 1114404548 | Amairany Madai Escamilla Meza | Physician Assistant | 410 E Pioneer Pkwy Ste 300, Grand Prairie, TX 75051-4984 | 2018-07-28 |
| 1447575162 | Angela Layton Hyden | Physician Assistant | 2520 W I 20, Grand Prairie, TX 75052-7280 | 2010-04-06 |
| 1447433784 | Wahoo House Calls, LLC | Physician Assistant | 1615 Babbling Brook Dr, Grand Prairie, TX 75050-8317 | 2007-12-10 |
| 1558493965 | Vitus Uchenna Nwafor | Physician Assistant | 2740 Eastland Dr, Grand Prairie, TX 75052-0738 | 2007-03-12 |
| 1568562957 | Nicole E Tribble | Physician Assistant | 3431 Jasper Dr, Grand Prairie, TX 75052-7872 | 2006-09-25 |
| 1912964503 | Cherie Bennett | Physician Assistant | 2455 Robinson Rd, Suite 200, Grand Prairie, TX 75051-3852 | 2006-04-27 |
| Find all providers in GRAND PRAIRIE | ||||
| City | GRAND PRAIRIE |
| Zip Code | 75052 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.