MEDICARE: MRS. LAKISHA SYMONE SUTTON PMHNP

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	5024540	NC

General Provider Information

NPI Number	:	1801182928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAKISHA SYMONE SUTTON PMHNP

Provider Business Mailing Address
First Line	:	184 SCOTT HILLS DR APT H1
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27530-8535
Country	:	US
Telephone Number	:	770-896-8958
Fax Number	:

Provider Business Practice Location Address
First Line	:	2719 GRAVES DR STE 5
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-4536
Country	:	US
Telephone Number	:	919-330-4367
Fax Number	:

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

Provider Enumeration Date	:	06/27/2011
Last Update Date	:	05/26/2026

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