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General NPI Number Information
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NPI Number | 1710801972
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Entity Type | Organization
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Legal Business Name | LOTUS BLUE MERIDIAN PSYCHIATRY, PLLC
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Dates
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Enumeration Date | 08/08/2026
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Last Update Date | 08/08/2026
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Provider Practice Location Address
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Address Line | 250 W 1ST ST STE 117
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City | WINSTON SALEM
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State | NC
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Zip | 27101-4055
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Country | US
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Telephone | 336-546-6249
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Fax |
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Provider Business Mailing Address
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Address Line | 357 TORTOISE LN
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City | WINSTON SALEM
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State | NC
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Zip | 27127-7005
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Country | US
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Telephone | 336-844-3141
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | KIMBERLY DAWSON
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Credential | NP
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Telephone | 336-844-3141
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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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