LORI ANGELEENE MODLY


Address: 743 Spring St Ne, Gainesville, GA 30501-3715
Phone: 7705353611

LORI ANGELEENE MODLY (NPI# 1871860692) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1871860692
Entity Type Individual
Full Name LORI ANGELEENE MODLY
Other Name LORI ANGELEENE O'SHEA
Credential CPNP
Practice Address 743 Spring St Ne
Gainesville
GA 30501-3715
Mailing Address Po Box 658
Gainesville
GA 30503-0658
Practice Telephone 7705353611
Practice Fax Number 7705357092
Mailing Telephone 7707181122
Mailing Fax Number 7705357445
Enumeration Date 2011-11-22
Last Update Date 2012-02-28
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LP0200X Nurse Practitioner
Specialization: Pediatrics
RN201247 GA Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
GA 003116595A 05
GA WELLCARE 643406 01
GA AMERIGROUP 01467542 01

Office Location

Street Address 743 SPRING ST NE
City GAINESVILLE
State GA
Zip Code 30501-3715

Providers in the same location

NPI Name Taxonomy Address Enumeration
1841293958 J. Taylor Henson Internal Medicine 743 Spring St Ne, Gainesville, GA 30501-3715 2005-05-23
1598362303 Rebecca Neff Anesthesiologist Assistant 743 Spring St Ne, Gainesville, GA 30501-3715 2020-10-05
1942817648 Frank James Vizen Registered Nurse 743 Spring St Ne, Gainesville, GA 30501-3715 2020-09-26
1285240580 Jennifer Erin Wood Nurse Practitioner 743 Spring St Ne, Gainesville, GA 30501-3715 2020-09-22
1174139026 Corey Barron Nurse Practitioner 743 Spring St Ne, Gainesville, GA 30501-3715 2020-09-16
1235743451 Christy Tepic Anesthesiologist Assistant 743 Spring St Ne, Gainesville, GA 30501-3715 2020-09-04
1073126439 Ashley Banks Nurse Practitioner 743 Spring St Ne, Gainesville, GA 30501-3715 2020-08-26
1144838665 Albert Duane Hancock Nurse Practitioner 743 Spring St Ne, Gainesville, GA 30501-3715 2020-07-21
1255957718 Krystle Dunn Pathology 743 Spring St Ne, Gainesville, GA 30501-3715 2020-06-21
1922624428 Abdullah Asreb Student in an Organized Health Care Education/Training Program 743 Spring St Ne, Gainesville, GA 30501-3715 2020-06-19
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1437782851 Madison Raye Huth Physician Assistant 743 Spring Street Se, Gainesville, GA 30501 2020-02-13
1205487659 Grace M Walker Brown Nurse Practitioner 592 Medical Park Dr., Suite A, Gainesville, GA 30501 2019-09-26
1174086987 Nayab Ahmed Student in an Organized Health Care Education/Training Program 743 Spring Street, Suite 710, Gainesville, GA 30501 2019-04-09
1154881118 Ryan D Berry Student in an Organized Health Care Education/Training Program 734 Spring St Se Ste 710, Gainesville, GA 30501 2019-03-24
1609336304 Harper E Niver Student in an Organized Health Care Education/Training Program 743 Spring St., Suite 710, Gainesville, GA 30501 2019-03-20
1508336173 Bradee Burrell Aderholt Nurse Practitioner 663 Lanier Park Drive, Gainesville, GA 30501 2018-11-27
1578068359 Soammy Liz Matias Chiropractor 961 Green Street, Gainesville, GA 30501 2018-03-26
1811496896 Matthew Brown Speech-Language Pathologist 500 Spring St. Se Suite 101, Gainesville, GA 30501 2018-02-06
1346769825 Dr. Skeete & Associates of North Georgia, P.C. Optometrist 150 Pearl Nix Parkway, Suite D3a, Gainesville, GA 30501 2017-09-15
1932624723 M & B Imaging, PC Radiology 1640 Jesse Jewell Pkwy Se Ste 2, Gainesville, GA 30501 2017-08-14
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Taxonomy Information

Taxonomy Code 363LP0200X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Pediatrics

Taxonomy Definition

Definition to come...

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NPI Name Taxonomy Address Enumeration
1588271233 Olivia Janelle De Jong Nurse Practitioner 424 Ne 6th St Apt D, Gainesville, FL 32601-5576 2020-09-28
1275771032 Wahida M. Siddiqi Nurse Practitioner 816 Sw 64th Ter, Gainesville, FL 32607-3556 2009-01-30
1588818843 Alma Marie Nakasone Nurse Practitioner 3030 Mcever Rd, Building 1 Suite 130, Gainesville, GA 30504-5579 2008-11-12
1023141959 Stacia Marie Hays Nurse Practitioner University of Florida College of Nursing, Box 100197, Gainesville, FL 32610-0197 2007-03-13
1790810760 Michelle Bowers Nurse Practitioner 2005 Sw 75th St, Gainesville, FL 32607-3425 2007-02-22
1194708065 Pamela Pieper Nurse Practitioner 101 S Newell Drive, Gainesville, FL 32611 2005-11-23
1104427251 Morgan Elizabeth Gilbert Nurse Practitioner 1600 Sw Archer Rd, Gainesville, FL 32610-3003 2020-11-05
1922628445 Kathryn Mary Mcfadden Nurse Practitioner 1699 Sw 16th Ave Bldg A, Gainesville, FL 32608-1158 2020-04-24
1699307314 Lauren Gooch Nurse Practitioner 1485 Jesse Jewell Pkwy Ne Ste 200, Gainesville, GA 30501-3802 2020-02-11
1902451610 Kristina Panagiotopoulos Nurse Practitioner 1600 Sw Archer Rd, Gainesville, FL 32610-3003 2019-08-08
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Competitor

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City GAINESVILLE
Zip Code 30501

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Dataset Information

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.

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