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General NPI Number Information
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NPI Number | 1225710866
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Entity Type | Organization
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Legal Business Name | PURPOSEFUL PEDIATRICS, PLLC
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Dates
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Enumeration Date | 08/03/2023
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 2509A LEWISVILLE CLEMMONS RD # 1004
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City | CLEMMONS
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State | NC
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Zip | 27012-8712
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Country | US
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Telephone | 336-608-7411
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Fax |
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Provider Business Mailing Address
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Address Line | 376 HOLLINSWOOD AVE
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City | WINSTON SALEM
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State | NC
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Zip | 27103-6245
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Country | US
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Telephone | 336-608-7411
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATINA DENA' LITTLE
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Credential | PNP
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Telephone | 336-608-7411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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