Healthcare Provider Details

I. General information

NPI: 1801182928
Provider Name (Legal Business Name): LAKISHA SYMONE SUTTON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 GRAVES DR STE 5
GOLDSBORO NC
27534-4536
US

IV. Provider business mailing address

184 SCOTT HILLS DR APT H1
GOLDSBORO NC
27530-8535
US

V. Phone/Fax

Practice location:
  • Phone: 919-330-4367
  • Fax: 919-330-4375
Mailing address:
  • Phone: 770-896-8958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5024540
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: