Healthcare Provider Details

I. General information

NPI: 1003735861
Provider Name (Legal Business Name): LAKESHA MCNEILL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 RAEFORD RD
FAYETTEVILLE NC
28305-5028
US

IV. Provider business mailing address

1404 RAEFORD RD
FAYETTEVILLE NC
28305-5028
US

V. Phone/Fax

Practice location:
  • Phone: 910-257-2815
  • Fax:
Mailing address:
  • Phone: 910-257-2815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5024917
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: