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

Mutiat Ajibade, NURSEPRACTITIONER

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1407480155

Mutiat Ajibade, NURSEPRACTITIONER is a Nurse Practitioner in Phialdelphia, Pennsylvania. Qualified in 2020, 6 years ago. Practices with Eastern Pennsylvania Physician Alliance, LLC, a 110-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Pennsylvania.

Years since qualifying
6
Licensed in
PA
In the registry since
2020

Practice location Address checks out

1401 S 31 St
Phialdelphia, PA 19146
Phone: (215) 925-2400
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence SP021594 (PA)

Record details

NPI number1407480155
Entity typeIndividual (Type 1)
GenderFemale
Credentials NURSEPRACTITIONER
Sole proprietorNo
NPI enumeratedMarch 2, 2020
Last updated in NPPESSeptember 11, 2023
Certification dateSeptember 11, 2023

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Eastern Pennsylvania Physician Alliance, Llc — 110 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare