Healthcare Provider Details

I. General information

NPI: 1003299561
Provider Name (Legal Business Name): CHRISHAUNDA LAKEISH VICK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 MEDICAL CAMPUS DR SJAFB
GOLDSBORO NC
27531-2310
US

IV. Provider business mailing address

8390 SIX FORKS RD STE 204
RALEIGH NC
27615-3060
US

V. Phone/Fax

Practice location:
  • Phone: 919-722-1509
  • Fax:
Mailing address:
  • Phone: 984-298-0087
  • Fax: 919-882-9653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5007728
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5007728
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: