| Wake County East Campus | |
|
220 Swinburne St Raleigh NC 27610-1834 | |
| (919) 212-9230 | |
| (919) 212-9233 |
| Full Name | Wake County East Campus |
|---|---|
| Speciality | Clinic/Center |
| Location | 220 Swinburne St, Raleigh, North Carolina |
| Authorized Official Name and Position | Jon Leizman (PRESIDENT) |
| Authorized Official Contact | 2164799063 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wake County East Campus 5500 Maryland Way Ste 400 Brentwood TN 37027-7048 Ph: (844) 407-7557 | Wake County East Campus 220 Swinburne St Raleigh NC 27610-1834 Ph: (919) 212-9230 |
| NPI Number | 1427575869 |
|---|---|
| Provider Enumeration Date | 08/25/2017 |
| Last Update Date | 01/06/2023 |
| Medicare PECOS PAC ID | 7315927597 |
|---|---|
| Medicare Enrollment ID | O20211104000772 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427575869 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Courtney W Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043309198 PECOS PAC ID: 2668426768 Enrollment ID: I20050311000148 |
| Provider Name | Heather M Fayhee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255326609 PECOS PAC ID: 6608894589 Enrollment ID: I20051109000578 |
| Provider Name | Jennifer M Mccreary |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053397919 PECOS PAC ID: 4880865054 Enrollment ID: I20110920000072 |
| Provider Name | Kristian Antionette Gibson-ford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841781119 PECOS PAC ID: 3476941840 Enrollment ID: I20211104001082 |
| Provider Name | Melissa Etchison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144579848 PECOS PAC ID: 4587814660 Enrollment ID: I20230321000066 |
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