Healthcare Provider Details

I. General information

NPI: 1760300602
Provider Name (Legal Business Name): LYSESHA R SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1916 S GLENBURNIE RD STE 9
NEW BERN NC
28562-5226
US

IV. Provider business mailing address

1916 S GLENBURNIE RD STE 9
NEW BERN NC
28562-5226
US

V. Phone/Fax

Practice location:
  • Phone: 252-229-9797
  • Fax:
Mailing address:
  • Phone: 252-229-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14287
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: