Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Bamidele Ganiyu

Individual provider Nurse Practitioner · NPI 1073155933

Bamidele Ganiyu is a Nurse Practitioner in Columbia, Missouri. Qualified in 2019, 7 years ago. Practices with Mercy ACO Clinical Services Inc, a 138-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Kansas and Missouri.

Years since qualifying
7
Licensed in
KS, MO
In the registry since
2019
Specialties on file
4
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Practice location Address checks out

2101 Corona Rd Ste 102
Columbia, MO 65203-2582
Phone: (573) 234-1800
Fax: (573) 234-1799
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 2020002143 (MO)
Nurse Practitioner Taxonomy 363L00000X · Licence 2020002143 (MO)
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X · Licence 83508 (KS)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1073155933
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedOctober 11, 2019
Last updated in NPPESNovember 19, 2024
Certification dateNovember 19, 2024
Mailing address616 Derek Dr, Wentzville, MO 63385-6841

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Mercy Aco Clinical Services Inc — 138 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

Other providers in Columbia