Healthcare Provider Details

I. General information

NPI: 1790692630
Provider Name (Legal Business Name): LAURAYSHA LEIGH MCMILLAN AJIBOYE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 COX BLVD STE 102
GOLDSBORO NC
27534-1695
US

IV. Provider business mailing address

208 COX BLVD STE 102
GOLDSBORO NC
27534-1695
US

V. Phone/Fax

Practice location:
  • Phone: 919-731-6018
  • Fax: 919-580-7010
Mailing address:
  • Phone: 919-731-6018
  • Fax: 919-580-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5025243
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: