MEDICARE: MRS. CHRISHAUNDA LAKEISH VICK FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	5007728	NC

General Provider Information

NPI Number	:	1003299561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISHAUNDA LAKEISH VICK FNP-C

Provider Business Mailing Address
First Line	:	2000 PERIMETER PARK DR
Second Line	:	STE 200
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-8442
Country	:	US
Telephone Number	:	919-923-6476
Fax Number	:

Provider Business Practice Location Address
First Line	:	8390 SIX FORKS RD STE 204
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-3060
Country	:	US
Telephone Number	:	984-298-0087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2015
Last Update Date	:	12/10/2025

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