Healthcare Provider Details

I. General information

NPI: 1427319698
Provider Name (Legal Business Name): JACQUETTA MELONY FOUSHEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SUNDAY DR STE 200
RALEIGH NC
27607-5151
US

IV. Provider business mailing address

1500 SUNDAY DR STE 200
RALEIGH NC
27607-5151
US

V. Phone/Fax

Practice location:
  • Phone: 919-322-2413
  • Fax: 919-322-2416
Mailing address:
  • Phone: 919-322-2413
  • Fax: 919-322-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2018-01538
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: