Modern Health & Wellness LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

MODERN HEALTH & WELLNESS LLC

Practice address

1010 N Belt Line Rd Ste 104
Mesquite, TX 75149-1770

Phone

(469) 659-9494

NPI assigned

Jul 24, 2020

Last updated

Jul 24, 2020By 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

Ketrina E Lewis, NP

Title

Nurse Practitioner

Phone

(469) 659-9494

Specialties & licenses 1

Addresses

Other names 2

• Modern Health & Wellness LLC Former legal business name
• Modern Health & Wellness Other name

Locations

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

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595548800000",
    "number": "1902415078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3229 WILTSHIRE HORN AVE STE 104",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750712844",
            "telephone_number": "702-812-9803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 N BELT LINE RD STE 104",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751491770",
            "telephone_number": "469-659-9494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN HEALTH & WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-24",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "KETRINA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "469-659-9494",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Modern Health & Wellness LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Modern Health & Wellness",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Multi-Specialty Clinic/Center in Mesquite, TX
• Providers in Mesquite, TX by specialty
• Multi-Specialty Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2020; 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.