Healthcare Provider Details

I. General information

NPI: 1922832898
Provider Name (Legal Business Name): JONATHAN SAUCIER DNP, APRN, PMHNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 SIX FORKS RD
RALEIGH NC
27609-0058
US

IV. Provider business mailing address

4820 SIX FORKS RD
RALEIGH NC
27609-0058
US

V. Phone/Fax

Practice location:
  • Phone: 910-273-7572
  • Fax: 984-220-9351
Mailing address:
  • Phone: 910-273-7572
  • Fax: 984-220-9351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5020832
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: