LILLYKUTTY A MODOOR (NPI# 1013155969) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013155969 |
| Entity Type | Individual |
| Full Name | LILLYKUTTY A MODOOR |
| Credential | NURSE PRACTITIONER |
| Practice Address |
650 Highland Ave Ste 100 Winston Salem NC 27101-4304 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 3366078523 |
| Practice Fax Number | 3367730916 |
| Mailing Telephone | 3362771800 |
| Mailing Fax Number | 3362776981 |
| Enumeration Date | 2009-01-30 |
| Last Update Date | 2020-01-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 5004280 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
5004280 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
5004280 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3333 Silas Creek Pkwy, Winston Salem, NC 271033013 | 3362771800 | 3362776981 |
| Street Address |
650 HIGHLAND AVE STE 100 |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27101-4304 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083763536 | Daymark Recovery Services Inc | Counselor | 650 Highland Ave Ste 100, Winston Salem, NC 27101-4304 | 2007-01-10 |
| 1417560970 | Anee Kaur | Physician Assistant | 650 Highland Ave Ste 100, Winston Salem, NC 27101-4304 | 2020-08-25 |
| 1104449305 | Matthew Reiland | Counselor | 650 Highland Ave Ste 100, Winston Salem, NC 27101-4304 | 2020-05-21 |
| 1265925465 | Alexandra Lundberg | Counselor | 650 Highland Ave Ste 100, Winston Salem, NC 27101-4304 | 2018-06-12 |
| 1740719202 | Freda Maria Davis | Social Worker | 650 Highland Ave Ste 100, Winston Salem, NC 27101 | 2017-06-08 |
| 1518369065 | Derrick Fowler | Counselor | 650 Highland Ave Ste 100, Winston Salem, NC 27101-4304 | 2014-09-16 |
| 1225385289 | Annette N Gaither | Counselor | 650 Highland Ave Ste 100, Winston Salem, NC 27101-4304 | 2012-08-09 |
| 1508169889 | Donna Lucille Roberson | Counselor | 650 Highland Ave Ste 100, Winston Salem, NC 27101 | 2010-12-08 |
| 1104034883 | Daymark Recovery Services Inc | Psychiatry & Neurology | 650 Highland Ave Ste 100, Winston Salem, NC 27101-4304 | 2007-05-18 |
| 1790807535 | Daymark Recovery Servcies Inc | Counselor | 650 Highland Ave Ste 100, Winston Salem, NC 27101 | 2007-04-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003421876 | Annie Carolina Mccollum | Occupational Therapist | 3 S Martin Luther King Jr Dr, Winston-salem, NC 27101 | 2020-09-09 |
| 1891321337 | Philippe Ayres | Personal Emergency Response Attendant | 475 Vine St., Bowman Gray Center for Medical Education, Winston-salem, NC 27101 | 2020-03-17 |
| 1497385595 | Aereil Moore | Counselor | 655 West 4th St, Winston Salem, NC 27101 | 2020-01-17 |
| 1619519428 | Brandi Melissa Decriscio | Nurse Practitioner | 1200 N Martin Luther King Jr Drive, Winston-salem, NC 27101 | 2019-10-14 |
| 1316502909 | Burke Street Chiropractic, Pllc | Chiropractor | 1016 Burke St., Winston-salem, NC 27101 | 2019-05-08 |
| 1790349728 | Nakia Carter | Counselor | 1o1o W. Northwest Boulevard, Winston-salem, NC 27101 | 2019-04-25 |
| 1003391251 | Hannah Fortwengler Rainey | Nurse Anesthetist, Certified Registered | Medical Center Blvrd, Winston-salem, NC 27101 | 2018-10-03 |
| 1750875928 | Susan Wilhelm Patterson | Nurse Practitioner | 1200 Martin Luther King Jr Dr, Winston-salem, NC 27101 | 2018-06-20 |
| 1194228049 | Anjanette Gilley Benjamin | Counselor | 650 Highland Ave Ste 1000, Winston Salem, NC 27101 | 2018-03-16 |
| 1376054627 | Paulisha Da-shawna Mcintyre | Social Worker | 650 Highland Ave Ste 101, Winston Salem, NC 27101 | 2017-10-13 |
| Find all providers in zip 27101 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184249393 | Adaku Anike | Nurse Practitioner | 1 Medical Center Blvd, Winston Salem, NC 27157-0001 | 2020-06-12 |
| 1043869746 | Lisa Maria Waye | Nurse Practitioner | 3637 Old Vineyard Rd, Winston Salem, NC 27104-4842 | 2019-09-05 |
| 1487015376 | Stefanie T Livingston | Nurse Practitioner | 380 Knollwood St # 505, Winston Salem, NC 27103-1884 | 2016-03-19 |
| 1053798694 | Valerie Vestal | Nurse Practitioner | 1615 Polo Rd, Winston Salem, NC 27106-3831 | 2015-05-04 |
| 1437498326 | Marjorie G Sales | Nurse Practitioner | 3000 Bethesda Pl, Suite 801, Winston Salem, NC 27103-3331 | 2013-02-12 |
| 1639436124 | Carolyn D Orr | Nurse Practitioner | 1615 Polo Rd, Winston Salem, NC 27106-3831 | 2012-04-20 |
| 1851454649 | Victoria Marie Soltis-jarrett | Nurse Practitioner | 1365 Westgate Center Dr, Winston Salem, NC 27103-2980 | 2006-12-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235730078 | Leetisha Lawana Dunia | Nurse Practitioner | 538 Wood Point Dr, Lillington, NC 27546-5971 | 2020-11-06 |
| 1881292134 | Jurell Kirice Riley | Nurse Practitioner | 6301 Dumont Ln, Charlotte, NC 28269-6147 | 2020-10-09 |
| 1336756899 | Jennifer Danks | Nurse Practitioner | 1845 Keener Rd, Clinton, NC 28328-8039 | 2020-09-29 |
| 1376159400 | Ronald Jerome Patterson Jr. | Nurse Practitioner | 4204 Banks Stone Dr, Raleigh, NC 27603-4860 | 2020-09-23 |
| 1902411499 | Solari Mental and Behavioral Health Services | Nurse Practitioner | 11206 Highcrest Dr, Huntersville, NC 28078-0610 | 2020-09-10 |
| 1699389684 | Lasting Hope - Mental Health & Recovery | Nurse Practitioner | 131 Fiddlers Run Blvd, Morganton, NC 28655-0095 | 2020-09-07 |
| 1588277727 | Alison Stroh | Nurse Practitioner | 1313 Banyon Grove Loop, Cary, NC 27513-3936 | 2020-08-27 |
| 1902417488 | Erin Klender Pllc | Nurse Practitioner | 12106 Willingdon Rd, Huntersville, NC 28078-5520 | 2020-08-10 |
| 1407466824 | Theresa Uju Ofoemezie | Nurse Practitioner | 250 S San Agustin Dr, Mooresville, NC 28117-8581 | 2020-08-01 |
| 1669090213 | Rashonda R. Wheeler | Nurse Practitioner | 8949 Cinnabay Dr, Charlotte, NC 28216-2189 | 2020-07-10 |
| Find all providers with the same taxonomy | ||||
| City | WINSTON SALEM |
| Zip Code | 27101 |
Please comment or provide details below to improve the information on LILLYKUTTY A MODOOR.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.