Provider Demographics
NPI:1467952879
Name:KIRUI-MODI, EMMY (NP-C)
Entity Type:Individual
Prefix:
First Name:EMMY
Middle Name:
Last Name:KIRUI-MODI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 STAR CT # T3
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-7353
Mailing Address - Country:US
Mailing Address - Phone:972-200-5001
Mailing Address - Fax:469-661-8625
Practice Address - Street 1:1360 STAR CT # T3
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-7353
Practice Address - Country:US
Practice Address - Phone:972-200-5001
Practice Address - Fax:469-661-8625
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135035363L00000X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care