Healthcare Provider Details

I. General information

NPI: 1194654657
Provider Name (Legal Business Name): MEDICAID MADE SIMPLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 NELSON ST
KINSTON NC
28501-3644
US

IV. Provider business mailing address

809 NELSON ST
KINSTON NC
28501-3644
US

V. Phone/Fax

Practice location:
  • Phone: 252-286-1033
  • Fax:
Mailing address:
  • Phone: 252-286-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: LAKISHA M BROWN
Title or Position: MANAGING MEMBER
Credential:
Phone: 252-286-1033