Provider Demographics
NPI:1114388014
Name:PHILLIP, NIMEKA NITRICE DUPREE (MD)
Entity Type:Individual
Prefix:
First Name:NIMEKA
Middle Name:NITRICE DUPREE
Last Name:PHILLIP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIMEKA
Other - Middle Name:NITRICE
Other - Last Name:DUPREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2579 CHIMNEY ROCK RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-9181
Mailing Address - Country:US
Mailing Address - Phone:828-696-1255
Mailing Address - Fax:
Practice Address - Street 1:2579 CHIMNEY ROCK RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-9181
Practice Address - Country:US
Practice Address - Phone:828-692-4289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-19
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC229925207Q00000X
390200000X
CAA163662208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program