MODUPE OLATUNDE – Psychiatric/Mental Health Nurse Practitioner, NPI 1063059756

MODUPE OLATUNDE is a healthcare provider. based in Grand prairie, Texas. specializing in NURSE PRACTITIONER. They hold a License No. AP143862 (TX). The NPI Number for MODUPE OLATUNDE is 1063059756

Main info

Female
7 Years Of Experience
Accepts Medicare Assignment
Name
MODUPE OLATUNDE
NPI
1063059756
Phone
(817) 733-7604
Address
6039 Cedar Glen Dr
Enumeration Date
2 December 2019
Last Update Date
8 December 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2143302488
Graduation Year
2019 (7 years ago)
PAC ID
1759789464
Group Practice PAC ID
2062308091
Professional Enrollment ID
I20211011002684
Address ID
TX750511527GR1020XPKWY400
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience36
Completeness85
Years active:6State licenses:1Digital endpointsOther names

22,204 NURSE PRACTITIONER in TX

Provider Addresses for MODUPE OLATUNDE

  • 6039 Cedar Glen Dr

    Grand Prairie, TX 750520409

    Phone: (817) 733-7604

    Type: Location

  • 6039 CEDAR GLEN DR

    GRAND PRAIRIE, TX 750520409

    Phone: (817) 733-7604

    Type: Location

  • 1020 S. CARRIER PWKY

    GRAND PRAIRIE, TX 75051

    Phone: (214) 743-1200

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2021-10-11

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20211011002684INurse PractitionerTXTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes10546$0
View full utilization report →

Insurance plans in this area (ZIP 75052)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2062308091View full group profile
NameSpecialtyState
Nurse PractitionerTX
Mental Health CounselorTX
Nurse PractitionerTX
P S Y C H I A T R YTX
P S Y C H I A T R YTX
-TX
Nurse PractitionerTX
Nurse PractitionerTX
Nurse PractitionerTX
Nurse PractitionerTX

Reviews

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Frequently asked questions

Does MODUPE OLATUNDE have a public NPI I can cite?
Public records show MODUPE OLATUNDE under NPI 1063059756.
Does the public listing show MODUPE OLATUNDE as active?
MODUPE OLATUNDE's NPI record reflects an active status in NPPES.
Which specialty label fits MODUPE OLATUNDE?
NPPES ties MODUPE OLATUNDE to Psychiatric/Mental Health Nurse Practitioner in the taxonomy section. Clinical services aligned with this taxonomy classification.
Is MODUPE OLATUNDE tied to Grand Prairie, Texas?
If you are local to Grand Prairie, Texas, MODUPE OLATUNDE may be relevant to your search.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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