Individual provider · Type 1 NPI

Modupe Oluwatoyin Idowu

Psychiatric/Mental Health Nurse Practitioner · Grand Prairie, TX

NPI number 1104680255 Active

Practice location

1801 S Carrier Pkwy
Grand Prairie, TX 75051-3702

Fax (972) 730-9801

Mailing address

7305 Aster Dr
Venus, TX 76084-3776

Specialties and licenses

TaxonomyCodeLicense
Psychiatric/Mental Health Nurse Practitioner Primary 363LP0808X1124176 (TX)

Psychiatric/Mental Health Nurse Practitioner: Definition to come...

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About NPI 1104680255

Modupe Oluwatoyin Idowu's National Provider Identifier is 1104680255, issued on Feb 9, 2024. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Grand Prairie, TX. The record was last updated on Apr 28, 2026.