MEDICARE: WAKEMED SPECIALISTS GROUP LLC

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	103G00000X	Clinical Neuropsychologist

General Provider Information

NPI Number	:	1770434375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAKEMED SPECIALISTS GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 808800
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-8800
Country	:	US
Telephone Number	:	877-498-4490
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 NEW BERN AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1231
Country	:	US
Telephone Number	:	919-350-0554
Fax Number	:

Authorized Official
Title or Position	:	EXEC DIRECTOR OPERATIONS
Name	:	KAREN REVICKI PERRY
Credential	:
Telephone Number	:	919-350-8000

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “WAKEMED SPECIALISTS GROUP LLC ” Practice Location

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