Individual provider Active NPI

Rachel Lichu Cullers, MSN, APRN, AGPCNP-BC

  • Gerontology Nurse Practitioner
  • Southlake, TX
National Provider Identifier
1407581895
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
1088010 Issued in TX
Practice address
Life's Medicine
700 E Southlake Blvd, Suite 130
Southlake, TX 76092
Phone
(817) 328-0331
Fax
(817) 251-9429
NPI assigned
Jul 19, 2022
Last updated
Apr 5, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 1088010 TX Primary

Addresses

Primary practice location

Life's Medicine
700 E Southlake Blvd, Suite 130
Southlake, TX 76092

Mailing address

1236 Southridge CT Ste 200
Hurst, TX 76053-4284
Phone (817) 406-1500

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20230126000640 TX Practitioner - Nurse Practitioner 3577934751 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1088010TXMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Segue Health of Texas PLLC CurrentSince Jan 31, 2023 Accepting new patients
Amber Hospice LLC PastSince Jul 1, 2022 Accepting new patients
Lenity Light Hospice - Dallas, LLC PastSince Jul 1, 2022 Accepting new patients

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1658188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712275200000",
    "number": "1407581895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1236 SOUTHRIDGE CT STE 200",
            "city": "HURST",
            "state": "TX",
            "postal_code": "760534284",
            "telephone_number": "817-406-1500",
            "fax_number": "817-928-5692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "LIFE'S MEDICINE",
            "address_2": "700 E SOUTHLAKE BLVD, SUITE 130",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "76092",
            "telephone_number": "817-328-0331",
            "fax_number": "817-251-9429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CULLERS",
        "first_name": "RACHEL",
        "middle_name": "LICHU",
        "name_prefix": "Mrs.",
        "credential": "MSN, APRN, AGPCNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-19",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "1088010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

Verify at the official NPI Registry.