Healthcare Provider Details

I. General information

NPI: 1346884731
Provider Name (Legal Business Name): NIAKESHA FRAZIER PMHNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N BENBOW ROAD
GREENSBORO NC
27411
US

IV. Provider business mailing address

112 N BENBOW ROAD
GREENSBORO NC
27411-1564
US

V. Phone/Fax

Practice location:
  • Phone: 336-624-5406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5012486
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012486
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number193403
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: