MEDICARE: RELIEF INTEGRATED HEALTHCARE

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	5004262	NC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5004262	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184143224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIEF INTEGRATED HEALTHCARE

Provider Business Mailing Address
First Line	:	3213 JESELLA DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-5556
Country	:	US
Telephone Number	:	919-422-2359
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 JOLLY ST
Second Line	:
City	:	LOUISBURG
State	:	NC
Zip	:	27549-2239
Country	:	US
Telephone Number	:	919-791-7745
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. CONNIE HICKS
Credential	:	DNP, NP, D-PMHNP
Telephone Number	:	919-422-2359

Provider Enumeration Date	:	09/10/2017
Last Update Date	:	09/10/2017

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Directions to “RELIEF INTEGRATED HEALTHCARE ” Practice Location

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