Provider Demographics
NPI:1790135150
Name:JEAN, LILYMIT MOKTAN (NP)
Entity Type:Individual
Prefix:
First Name:LILYMIT
Middle Name:MOKTAN
Last Name:JEAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 VALLEY VIEW LN STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5045
Mailing Address - Country:US
Mailing Address - Phone:972-715-3800
Mailing Address - Fax:
Practice Address - Street 1:741 PLUMMER RD
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-3815
Practice Address - Country:US
Practice Address - Phone:552-380-7409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-122814363L00000X, 363LA2100X
AL1-12814363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health