MEDICARE: HER PSYCHIATRY WELLNESS

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	:	1912841552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HER PSYCHIATRY WELLNESS

Provider Business Mailing Address
First Line	:	1776 HERITAGE CENTER DR STE 104
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-3977
Country	:	US
Telephone Number	:	919-561-3770
Fax Number	:	201-917-1257

Provider Business Practice Location Address
First Line	:	1776 HERITAGE CENTER DR STE 104
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-3977
Country	:	US
Telephone Number	:	919-561-3770
Fax Number	:	919-561-3770

Authorized Official
Title or Position	:	MSN, PMHNP-BC
Name	:	NATALIE PEARL DAVID
Credential	:	PMHNP
Telephone Number	:	919-561-3770

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	06/10/2026

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