Provider Demographics
NPI:1164857124
Name:STARKES-PERRY, TAKIA SHAWNTA (FNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:TAKIA
Middle Name:SHAWNTA
Last Name:STARKES-PERRY
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:TAKIA
Other - Middle Name:SHAWNTA
Other - Last Name:STARKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4002 SPRING GARDEN ST STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1626
Practice Address - Country:US
Practice Address - Phone:336-553-0793
Practice Address - Fax:336-553-0795
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179615363LP0808X
NC5006433363LP0808X
NC233848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCH757AMedicare PIN