Pure-Ivy Health Care Inc

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

PURE-IVY HEALTH CARE INC

Practice address

1119 Westgate Dr
Lilburn, GA 30047-3272

Phone

(678) 789-2123

NPI assigned

Aug 28, 2019

Last updated

Dec 3, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Adewunmi SokanNPI 1093184194

Title

Administrator

Phone

(678) 789-2123

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Adewunmi Sokan

  • Psychiatric/Mental Health Nurse Practitioner
  • Lilburn, GA
  • NPI 1093184194
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1566950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1134777667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1119 WESTGATE DR",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473272",
            "telephone_number": "678-789-2123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 WESTGATE DR",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473272",
            "telephone_number": "678-789-2123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURE-IVY HEALTH CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-28",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A",
        "authorized_official_last_name": "SOKAN",
        "authorized_official_first_name": "ADEWUNMI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "678-789-2123"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Lilburn, GA
• Providers in Lilburn, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.