Healthcare Provider Details

I. General information

NPI: 1295132470
Provider Name (Legal Business Name): LAKEESHA PURYEAR DNP,MSN, APRN,AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 01/08/2023
Certification Date: 01/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 S HORNER BLVD
SANFORD NC
27332-8032
US

IV. Provider business mailing address

3933 PATRIOT RIDGE CT
RALEIGH NC
27610-6459
US

V. Phone/Fax

Practice location:
  • Phone: 919-718-0414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number197031
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number197031
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number197031
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG7210053
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: