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General NPI Number Information
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NPI Number | 1770434375
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Entity Type | Organization
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Legal Business Name | WAKEMED SPECIALISTS GROUP LLC
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Dates
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Enumeration Date | 02/09/2026
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 3000 NEW BERN AVE
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City | RALEIGH
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State | NC
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Zip | 27610-1231
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Country | US
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Telephone | 919-350-0554
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 808800
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City | KANSAS CITY
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State | MO
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Zip | 64180-8800
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Country | US
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Telephone | 877-498-4490
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Fax |
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Authorized Official
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Title or Position | EXEC DIRECTOR OPERATIONS
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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