=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861763534
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POSITIVE PERCEPTIONS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2012
-----------------------------------------------------
Last Update Date | 03/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10150 MALLARD CREEK RD STE 104
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28262-4567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-966-7710
-----------------------------------------------------
Fax | 704-496-2203
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19701 BETHEL CHURCH RD STE 103-233
-----------------------------------------------------
City | CORNELIUS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28031-4072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-966-7710
-----------------------------------------------------
Fax | 704-496-2203
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NP/CEO
-----------------------------------------------------
Name | LATASHA REGENIA ROGERS
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 704-966-7710
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5003950
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 5003950
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------