MODUPE AGBEYOMI, DNP, FNP-C — NPI 1245715903 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family in BROOKHAVEN, GA)

CMS-1500 Box 24J / 33a • NPI

1245715903

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363LF0000X (CMS 50)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family

Box 32 Service Location & ZIP+4

13 CORPORATE BLVD NE STE 200, BROOKHAVEN, GA, 30329-1900

✓ 9-Digit EDI 837 ZIP+4 (30329-1900)

Practice Phone & Referral Fax

(770) 557-1079

Fax: (770) 872-6621

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1245715903 (MODUPE AGBEYOMI, DNP, FNP-C) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1245715903` (NPI-1 Individual Practitioner)
Provider / Legal Name	MODUPE AGBEYOMI, DNP, FNP-C
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family NUCC Code: `363LF0000X` (Nurse Practitioner, Family)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	13 CORPORATE BLVD NE STE 200, BROOKHAVEN, GA, 30329-1900
Practice Telephone / Fax	Tel: (770) 557-1079 \| Fax: (770) 872-6621
Administrative Mailing Address	13 CORPORATE BLVD NE STE 200, BROOKHAVEN, GA, 30329-1900
Enumeration & Last Sync	Enumerated: 2018-09-28 \| CMS Record Updated: 2023-11-29

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

13 CORPORATE BLVD NE STE 200, BROOKHAVEN, GA, 30329-1900

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Plain-English Taxonomy & CMS Crosswalk (363LF0000X)

What Does Taxonomy Code 363LF0000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LF0000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 50 (Nurse Practitioner)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nurse Practitioner, Family for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MODUPE AGBEYOMI, DNP, FNP-C)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`251F00000X` — Home Infusion Plain English: Licensed & Credentialed Home Infusion	State: N/A \| License: `Verified` \| Primary: Secondary
`261QI0500X` — Clinic/Center, Infusion Therapy Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QM1000X` — Clinic/Center, Migrant Health Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`363LP2300X` — Nurse Practitioner, Primary Care Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Primary Care	State: GA \| License: `F09180151` \| Primary: Secondary
`363LS0200X` — Nurse Practitioner, School Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, School	State: GA \| License: `F09180151` \| Primary: Secondary
`363LF0000X` — Nurse Practitioner, Family Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family	State: GA \| License: `F09180151` \| Primary: Yes (Primary)

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MODUPE AGBEYOMI, DNP, FNP-C (NPI #1245715903)