Modify, PLLC

Primary specialty

Adult Health Clinical Nurse SpecialistTaxonomy code 364SA2200X

Legal business name

MODIFY, PLLC

Practice address

7804 E 108TH St Ste a
Tulsa, OK 74133-7423

Phone

(918) 857-2135

NPI assigned

Mar 22, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Amanda Jo Wyatt, DNP, APRN-CNS,BC-ADM

Title

Owner

Phone

(918) 857-2135

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1679443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1871295774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8263 S HARVARD AVE # 715",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741371614",
            "telephone_number": "918-857-2135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7804 E 108TH ST STE A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741337423",
            "telephone_number": "918-857-2135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODIFY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-22",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-857-2135",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP, APRN-CNS,BC-ADM"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SA2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyndal Rae Moctezuma, RN
• Megan J Moddelmog, MSPT
• Richard Young Modenbach, LCSW
• Allison Kate Modglin
• Jay Modi
• Kristen Dawn Moeller
• Roxann Renee Moeller, LCSW
• Sareesa Moeller
• Jerry Moffatt
• Meredith L. Mogan, PA-C

• Adult Health Clinical Nurse Specialist in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Adult Health Clinical Nurse Specialist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; 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.