Raven Modisette, FNP-C,PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP137299 Issued in TX

Practice address

3901 Arlington Highlands Blvd
Ste 200
Arlington, TX 76018-6050

Phone

(817) 695-5035

NPI assigned

Oct 26, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Ms. Raven Modisette Professional name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Elite Psychiatry PC

  • Psychiatry Physician
  • Arlington, TX
  • NPI 1952888265

  Family

  Medicare reassignment NPD Authorized official
• Elite Psychiatry PC

  • Psychiatry Physician
  • Arlington, TX
  • NPI 1770060691

  Nurse Practitioner

  NPD Authorized official
• Purple Hearts Integrated Community Outreach Services

  • Community Health Clinic/Center
  • Grand Prairie, TX
  • NPI 1962181370
  NPD Authorized official
• Purple Hearts Case Management Services

  • Case Management Agency
  • Cedar Hill, TX
  • NPI 1912459777
  NPD (past) Authorized official

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

{
    "created_epoch": "1477440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655424000000",
    "number": "1225580293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 ARLINGTON HIGHLANDS BLVD",
            "address_2": "STE 200",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760186050",
            "telephone_number": "817-695-5035",
            "fax_number": "817-695-5037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 ARLINGTON HIGHLANDS BLVD",
            "address_2": "STE 200",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760186050",
            "telephone_number": "817-695-5035"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3901 Arlington Highlands Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "TX",
            "postal_code": "760186050",
            "country_code": "US",
            "telephone_number": "817-695-5035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MODISETTE",
        "first_name": "RAVEN",
        "name_prefix": "Ms.",
        "credential": "FNP-C,PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-26",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP137299",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP137299",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP137299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RAVEN",
            "last_name": "MODISETTE",
            "prefix": "MS.",
            "credential": "FNP-C, PMHNP-BC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Edward E Moayyad, MD
• Mobilab Diagnostics, LLC
• Mobile Eeg Testing Inc
• Mobile Medical Examiners
• Kenya Mobley
• Modus Vivendi Chiropractic PLLC
• Beryl Moenga
• Catherine Moffett, PA-C
• Kenneth Wayne Moffett Sr., REGISTERED CERTIFIED
• Susan Obencha Mogaka Jr.

• Psychiatric/Mental Health Nurse Practitioner in Arlington, TX
• Providers in Arlington, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.