Healthcare Provider Details

I. General information

NPI: 1508569401
Provider Name (Legal Business Name): DENISA SAVANNAH PUCKETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 NC-105 EXTENSION, SUITE 102
BOONE NC
26807
US

IV. Provider business mailing address

148 NC-105 EXTENSION, SUITE 102
BOONE NC
26807
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025-00902
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: