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

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1104680255

Modupe Oluwatoyin Idowu is a Nurse Practitioner in Grand Prairie, Texas. Qualified in 2023, 3 years ago. Practices as a sole proprietor. Licensed in Texas.

Years since qualifying
3
Licensed in
TX
In the registry since
2024
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Practice location Address checks out

1801 S Carrier Pkwy
Grand Prairie, TX 75051-3702
Phone: (972) 433-0088
Fax: (972) 730-9801
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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 1124176 (TX)

Record details

NPI number1104680255
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedFebruary 9, 2024
Last updated in NPPESApril 28, 2026
Certification dateApril 28, 2026

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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