Healthcare Provider Details

I. General information

NPI: 1861864324
Provider Name (Legal Business Name): DELETHIA LEMAR LLOYD AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 CROASDAILE FARM PKWY AMBULATORY CARE CLINIC
DURHAM NC
27705-1331
US

IV. Provider business mailing address

2600 CROASDAILE FARM PKWY AMBULATORY CARE CLINIC
DURHAM NC
27705-1331
US

V. Phone/Fax

Practice location:
  • Phone: 919-384-2571
  • Fax:
Mailing address:
  • Phone: 919-384-2571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5008129
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5008129
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: