Healthcare Provider Details

I. General information

NPI: 1134639867
Provider Name (Legal Business Name): JEANNE MARIE LYTHGOE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 08/16/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2153 VALLEYGATE DR STE 101
FAYETTEVILLE NC
28304-3667
US

IV. Provider business mailing address

129 TUXFORD CT
RAEFORD NC
28376-6798
US

V. Phone/Fax

Practice location:
  • Phone: 910-672-0350
  • Fax: 910-672-0355
Mailing address:
  • Phone: 910-670-2010
  • Fax: 910-565-2218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5009890
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: