Healthcare Provider Details

I. General information

NPI: 1558233924
Provider Name (Legal Business Name): PRAGYA SITOULA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 GATEWAY BLVD STE C
MOORESVILLE NC
28117-5544
US

IV. Provider business mailing address

122 GATEWAY BLVD STE C
MOORESVILLE NC
28117-5544
US

V. Phone/Fax

Practice location:
  • Phone: 980-766-1030
  • Fax:
Mailing address:
  • Phone: 704-360-3637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number350364
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5023129
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: