Prodigy Health and Wellness PLLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

PRODIGY HEALTH AND WELLNESS PLLC

Practice address

4000 Wake Forest Rd
Raleigh, NC 27609-6879

Phone

(919) 793-6483

NPI assigned

Oct 12, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lisa P. Blevins, DNPNPI 1073707311

Title

Nurse Practitioner

Phone

(919) 793-6483

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Prodigy Health & Wellness PLLC Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Patrice Blevins, APRN-BC

  • Family Nurse Practitioner
  • Raleigh, NC
  • NPI 1073707311
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1697068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697068800000",
    "number": "1740061886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 376",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275450376",
            "telephone_number": "919-793-6483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 WAKE FOREST RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276096879",
            "telephone_number": "919-793-6483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRODIGY HEALTH AND WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-12",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A",
        "authorized_official_last_name": "BLEVINS",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "919-793-6483",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY MEDICINE",
            "identifier": "5003510",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prodigy Health & Wellness PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniel Prober
• Cheryl Proctor, F.N.P.
• Jacob Lee Proctor, PT
• Leah Ann Proctor, PHARMD
• Mary Rachels Proctor, CRNA
• Prodigy Healthcare Services Inc.
• Karyn Lena Proeschel
• Kris Elisabeth Proeschel, RPAC
• Professional Counseling Associates of Cary
• Professional Group Living, LLC

• Primary Care Nurse Practitioner in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Primary Care Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.