Organization
PRODIGY HEALTH AND WELLNESS PLLC
Active
Organization
PRODIGY HEALTH AND WELLNESS PLLC
Active
Other names
Prodigy Health & Wellness PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
LISA P. BLEVINS DNP (NURSE PRACTITIONER)
(919) 793-6483
Entity
Organization
Contact information
Practice address
4000 WAKE FOREST RD, RALEIGH, NC 27609-6879
(919) 793-6483
Mailing address
PO BOX 376, KNIGHTDALE, NC 27545-0376
(919) 793-6483
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5003510
FAMILY MEDICINE
NC
Enumeration date
10/12/2023
Last updated
10/12/2023
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