OYERONKE O AJIBOYE-LALA, NP — NPI 1073920203 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric

CMS-1500 Box 24J / 33a • NPI

1073920203

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363LP0808X (CMS 50)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health

Box 32 Service Location & ZIP+4

1701 N DOUGLAS AVE, DOUGLAS, AZ, 85607-1019

✓ 9-Digit EDI 837 ZIP+4 (85607-1019)

Practice Phone & Referral Fax

(520) 366-3133

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1073920203 (OYERONKE O AJIBOYE-LALA, NP) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Medicare Part B

✓ Eligible

DMEPOS Ordering

✓ Eligible

Home Health (HHA)

✓ Eligible

Power Mobility

✓ Eligible

Hospice Referring

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1073920203` (NPI-1 Individual Practitioner)
Provider / Legal Name	OYERONKE O AJIBOYE-LALA, NP
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health NUCC Code: `363LP0808X` (Nurse Practitioner, Psych/Mental Health)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1701 N DOUGLAS AVE, DOUGLAS, AZ, 85607-1019
Practice Telephone / Fax	Tel: (520) 366-3133
Administrative Mailing Address	3651 PEACHTREE PARKWAY, SUWANEE, GA, 30024
Enumeration & Last Sync	Enumerated: 2014-07-21 \| CMS Record Updated: 2026-04-02

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1701 N DOUGLAS AVE, DOUGLAS, AZ, 85607-1019

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Plain-English Taxonomy & CMS Crosswalk (363LP0808X)

What Does Taxonomy Code 363LP0808X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LP0808X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 50 (Nurse Practitioner)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nurse Practitioner, Psych/Mental Health for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (OYERONKE O AJIBOYE-LALA, NP)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`363LP0808X` — Nurse Practitioner, Psych/Mental Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health	State: CA \| License: `95019627` \| Primary: Secondary
`363LP0808X` — Nurse Practitioner, Psych/Mental Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health	State: NY \| License: `404390` \| Primary: Secondary
`363LP0808X` — Nurse Practitioner, Psych/Mental Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health	State: GA \| License: `APRN-NP201907` \| Primary: Secondary
`363LP0808X` — Nurse Practitioner, Psych/Mental Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health	State: CO \| License: `C-APN.0100643-C-NP` \| Primary: Secondary
`363LP0808X` — Nurse Practitioner, Psych/Mental Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health	State: MA \| License: `RN2349570` \| Primary: Secondary
`363LP0808X` — Nurse Practitioner, Psych/Mental Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health	State: NM \| License: `72860` \| Primary: Secondary
`363LP0808X` — Nurse Practitioner, Psych/Mental Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health	State: FL \| License: `APRN11011367` \| Primary: Secondary
`363LP0808X` — Nurse Practitioner, Psych/Mental Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health	State: DE \| License: `L8-0010430` \| Primary: Secondary
`363LP0808X` — Nurse Practitioner, Psych/Mental Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health	State: OR \| License: `202103599NP-PP` \| Primary: Secondary
`363LP0808X` — Nurse Practitioner, Psych/Mental Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health	State: KS \| License: `53-82112-121` \| Primary: Secondary
`363LP0808X` — Nurse Practitioner, Psych/Mental Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health	State: MD \| License: `AC005293` \| Primary: Secondary
`363LP0808X` — Nurse Practitioner, Psych/Mental Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health	State: AZ \| License: `AP11428` \| Primary: Yes (Primary)
`363LP0808X` — Nurse Practitioner, Psych/Mental Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health	State: WA \| License: `AP61054931` \| Primary: Secondary
`363L00000X` — Nurse Practitioner Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner	State: GA \| License: `RN201907` \| Primary: Secondary

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OYERONKE O AJIBOYE-LALA, NP (NPI #1073920203)

CMS Medicare Order & Referring PECOS Eligibility

Official CMS NPPES Credential & Practice Profile

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

What Does Taxonomy Code 363LP0808X Mean?

Standard Scope of Care (OYERONKE O AJIBOYE-LALA, NP)

All Registered NUCC Taxonomies & State Licenses