Healthcare Provider Details

I. General information

NPI: 1508394347
Provider Name (Legal Business Name): LISA MEJIA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ROUNTREE

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 S 16TH ST STE A
WILMINGTON NC
28401-6491
US

IV. Provider business mailing address

PO BOX 15109
WILMINGTON NC
28408-5109
US

V. Phone/Fax

Practice location:
  • Phone: 910-452-8633
  • Fax: 910-452-8589
Mailing address:
  • Phone: 910-392-2525
  • Fax: 910-392-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5022025
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF343193
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: