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General NPI Number Information
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NPI Number | 1174491138
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Entity Type | Organization
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Legal Business Name | WAKE SPECIALTY PHYSICIANS LLC
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Dates
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Enumeration Date | 10/29/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 9648 CHAPEL HILL RD
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City | MORRISVILLE
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State | NC
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Zip | 27560
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Country | US
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Telephone | 919-350-0365
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 803854
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City | KANSAS CITY
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State | MO
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Zip | 64180-3854
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Country | US
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Telephone | 877-498-4490
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Fax | 919-350-7687
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR OPERATIONS WPP
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Name | KAREN REVICKI PERRY
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Credential |
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Telephone | 919-350-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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