Provider Demographics
NPI:1275950453
Name:PAYIKKATTU, JILJI (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JILJI
Middle Name:
Last Name:PAYIKKATTU
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:JILJI
Other - Middle Name:
Other - Last Name:PAYIKKATTU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC, PMHNP-BC
Mailing Address - Street 1:3184 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9074
Mailing Address - Country:US
Mailing Address - Phone:469-777-4102
Mailing Address - Fax:
Practice Address - Street 1:3184 PRESTON RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9074
Practice Address - Country:US
Practice Address - Phone:469-777-4102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125455363LP0808X, 363LF0000X
TX711177163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15626OtherRX. AUTH. NUMBER