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General NPI Number Information
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NPI Number | 1427945518
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Entity Type | Organization
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Legal Business Name | KAILO'S MENTAL RETREAT
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Dates
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Enumeration Date | 06/20/2025
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 748 ADDINGTON DR
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City | WINTERVILLE
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State | NC
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Zip | 28590-7102
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Country | US
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Telephone | 252-414-3318
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Fax | 252-677-6551
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Provider Business Mailing Address
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Address Line | 748 ADDINGTON DR
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City | WINTERVILLE
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State | NC
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Zip | 28590-7102
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Country | US
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Telephone | 252-414-3318
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Fax | 252-677-6551
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Authorized Official
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Title or Position | MSN, PMHNP-C
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Name | LISA MICHELLE MOORE
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Credential | PMHNP-C
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Telephone | 252-414-3318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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