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NPI Code Detail

MEDICARE: LAKETA BUMPERS

MEDICARE: LAKETA BUMPERS
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
1164W00000XLicensed Practical Nurse88922NC

General Provider Information

NPI Number : 1043146194
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAKETA BUMPERS
Provider Business Mailing Address
First Line : 6118 SAINT GILES ST STE 130
Second Line :
City : RALEIGH
State : NC
Zip : 27612-7099
Country : US
Telephone Number : 919-910-0800
Fax Number : 919-341-5068
Provider Business Practice Location Address
First Line : 6118 SAINT GILES ST STE 130
Second Line :
City : RALEIGH
State : NC
Zip : 27612-7099
Country : US
Telephone Number : 919-910-0800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2026
Last Update Date : 06/18/2026

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Directions to “ LAKETA BUMPERS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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