Lillywyte LLC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

2612 Issued in CO

Legal business name

LILLYWYTE LLC

Practice address

8418 Colonial Dr
Lone Tree, CO 80124-9738

Phone

(281) 462-1285

Fax

(281) 462-1554

NPI assigned

Jan 29, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shelly Jatana

Title

Representative

Phone

(303) 944-4085

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276732800000",
    "number": "1013194380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1288",
            "city": "CROSBY",
            "state": "TX",
            "postal_code": "775321288",
            "telephone_number": "281-462-1285",
            "fax_number": "281-462-1554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8418 COLONIAL DR",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801249738",
            "telephone_number": "281-462-1285",
            "fax_number": "281-462-1554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILLYWYTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-29",
        "last_updated": "2010-06-17",
        "status": "A",
        "authorized_official_last_name": "JATANA",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "REPRESENTATIVE",
        "authorized_official_telephone_number": "303-944-4085"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "2612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.