Healthcare Provider Details

I. General information

NPI: 1609658665
Provider Name (Legal Business Name): LAQUITA BALMER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9425 NC HIGHWAY 305
JACKSON NC
27845-9679
US

IV. Provider business mailing address

PO BOX 640
ROANOKE RAPIDS NC
27870-0640
US

V. Phone/Fax

Practice location:
  • Phone: 252-534-1661
  • Fax:
Mailing address:
  • Phone: 252-536-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5019193
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: