MEDICARE: BIG DREAMERS YOUTH ON THE RISE PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1154991834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIG DREAMERS YOUTH ON THE RISE PLLC

Provider Business Mailing Address
First Line	:	1213 ARTEMIS DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-0149
Country	:	US
Telephone Number	:	910-584-5747
Fax Number	:

Provider Business Practice Location Address
First Line	:	1213 ARTEMIS DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-0149
Country	:	US
Telephone Number	:	910-584-5747
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ELZONA PATTERSON
Credential	:	PMHNP
Telephone Number	:	910-584-5747

Provider Enumeration Date	:	06/25/2021
Last Update Date	:	06/25/2021

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