Healthcare Provider Details

I. General information

NPI: 1700709219
Provider Name (Legal Business Name): SMILING LLAMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 HILL LN
BRACEY VA
23919-2174
US

IV. Provider business mailing address

PO BOX 378
BRACEY VA
23919-0378
US

V. Phone/Fax

Practice location:
  • Phone: 919-995-5421
  • Fax: 903-213-9122
Mailing address:
  • Phone: 919-995-5421
  • Fax: 903-213-9122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORI DILLARD FUQUAY
Title or Position: NURSE PRACTITIONER
Credential: FNP
Phone: 919-995-5421