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General NPI Number Information
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NPI Number | 1952811267
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Entity Type | Organization
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Legal Business Name | LIVE WELL PRIMARY CARE
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 4064 BARRETT DR UNIT 9A
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City | RALEIGH
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State | NC
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Zip | 27609-6604
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Country | US
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Telephone | 919-803-4188
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Fax |
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Provider Business Mailing Address
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Address Line | 4064 BARRETT DR UNIT 9A
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City | RALEIGH
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State | NC
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Zip | 27609-6604
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Country | US
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Telephone | 919-803-4188
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DATANYA YVETTS BETTS
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Credential | FNP
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Telephone | 919-803-4188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5006305
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License Number State | NC
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