OLUWATOSIN B AJIBOLA
NPI 1063230464
Nurse Practitioner - Family in Grand Prairie, TX

Q: What is Oluwatosin Ajibola's NPI number?

The NPI number for Oluwatosin Ajibola is 1063230464. It was assigned to this individual provider in the NPPES registry on October 3, 2024.

Q: What is Oluwatosin Ajibola's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Active since October 03, 2024PECOS Enrolled

4927 LAKE RIDGE PKWY STE 148, GRAND PRAIRIE, TX 75052(972) 217-4203 Get Directions Write a Review

NPPES record last updated: September 4, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 4, 2025, Oct 3, 2024 (2 updates tracked since 2024).

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About Oluwatosin B Ajibola NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

OLUWATOSIN B AJIBOLA (NPI 1063230464) is an individual family provider in Grand Prairie, Texas, licensed in Texas (1177043) and active in the NPI registry since October 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1063230464

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameOLUWATOSIN B AJIBOLA

Location Address4927 LAKE RIDGE PKWY STE 148Grand Prairie, TX 75052-3000

Mailing Address4927 Lake Ridge Pkwy Ste 148Grand Prairie, TX 75052-3000 · (972) 217-4203

Phone(972) 217-4203

Sole ProprietorYes

Medical School CMSOtherGraduated 2024

Enumeration DateOctober 3, 2024

Last NPPES UpdateSeptember 4, 20252 updates tracked since enumeration

NPPES CertifiedSeptember 4, 2025

✔ NPI 1063230464 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in TX · 1177043

4927 LAKE RIDGE PKWY STE 148, Grand Prairie, TX 75052

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Oluwatosin B Ajibola is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID2961992615

PECOS Enrollment IDI20251110003697

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 75052 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$88.19 typical visit price

range $57.18 – $172.86

Typical copayment $22.04 (range $14.29 – $43.21)

Most-billed visit code 99203

Established Patient

$100.80 typical visit price

range $18.48 – $141.20

Typical copayment $25.20 (range $4.62 – $35.30)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JUDY ANN DAO

Nurse Practitioner (Family)