Healthcare Provider Details

I. General information

NPI: 1760189880
Provider Name (Legal Business Name): LADERRIA WHITTED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 09/28/2025
Certification Date: 09/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 NC-24
BISCOE NC
27209
US

IV. Provider business mailing address

6702 WHISPER CREEK DR
WHITSETT NC
27377-9818
US

V. Phone/Fax

Practice location:
  • Phone: 910-828-1131
  • Fax:
Mailing address:
  • Phone: 919-608-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5017609
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022057057
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: