Healthcare Provider Details

I. General information

NPI: 1275413320
Provider Name (Legal Business Name): MORGAN PROFFITT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1748 HERITAGE CENTER DR STE 101
WAKE FOREST NC
27587-9855
US

IV. Provider business mailing address

1748 HERITAGE CENTER DR STE 101
WAKE FOREST NC
27587-9855
US

V. Phone/Fax

Practice location:
  • Phone: 919-529-5920
  • Fax: 919-529-5933
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5024585
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number356675
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: