PRODIGY HEALTH AND WELLNESS PLLC NPI 1740061886

NPI Information

NPI: 1740061886
Provider Name: PRODIGY HEALTH AND WELLNESS PLLC
Classification: Nurse Practitioner - 363LP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 34D2292347

Address:
4000 WAKE FOREST RD
RALEIGH, NC
ZIP 27609
Phone: (919) 793-6483
Get Directions

PRODIGY HEALTH AND WELLNESS PLLC is a primary care nurse practitioner in Raleigh, NC. PRODIGY HEALTH AND WELLNESS PLLC NPI is 1740061886. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4000 WAKE FOREST RD
RALEIGH, NC
ZIP 27609-879
Phone: (919) 793-6483

The provider's authorized official is Lisa P. Blevins .
The authorized official title is Nurse Practitioner and has the following contact phone number (919) 793-6483.

The CLIA number assigned to this NPI record is 34D2292347 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/12/2023 and was last updated on 10/12/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP2300X	Nurse Practitioner	Primary Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	5003510	OTHER	NORTH CAROLINA	FAMILY MEDICINE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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