Individual provider · Type 1 NPI

Lillykutty Abraham Modoor, NURSE PRACTITIONER

Psychiatric/Mental Health Nurse Practitioner · Winston Salem, NC

NPI number 1013155969 Active

Practice location

650 Highland Ave Ste 100
Winston Salem, NC 27101-4304

Call (336) 607-8523 Map

Fax (336) 773-0916

Mailing address

284 Executive Park Dr Ste 100
Concord, NC 28025-1833

Other practice locations

  • 725 Highland Ave Unit 116, Winston Salem, NC 27101-4181 · (336) 703-3250

Specialties and licenses

TaxonomyCodeLicense
Nurse Practitioner 363L00000X5004280 (NC)
Family Nurse Practitioner 363LF0000X5004280 (NC)
Psychiatric/Mental Health Nurse Practitioner Primary 363LP0808X5004280 (NC)

Psychiatric/Mental Health Nurse Practitioner: Definition to come...

10 other providers at this address

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About NPI 1013155969

Lillykutty Abraham Modoor, NURSE PRACTITIONER's National Provider Identifier is 1013155969, issued on Jan 30, 2009. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Winston Salem, NC. The record was last updated on Feb 6, 2023.