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
State | License ID | Taxonomies |
---|---|---|
TX | AP135035 | 363L00000X, 363LP2300X, 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
No | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |