MEDICARE: JACQUETTA MELONY FOUSHEE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	2018-01538	NC
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1427319698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUETTA MELONY FOUSHEE M.D.

Provider Business Mailing Address
First Line	:	8502 SIX FORKS RD STE 102
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-3264
Country	:	US
Telephone Number	:	984-207-1098
Fax Number	:	984-202-2194

Provider Business Practice Location Address
First Line	:	8502 SIX FORKS RD STE 102
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-3264
Country	:	US
Telephone Number	:	984-207-1098
Fax Number	:	984-202-2194

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	01/13/2026

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