Provider Demographics
NPI:1225710866
Name:PURPOSEFUL PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:PURPOSEFUL PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:DENA'
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:PNP
Authorized Official - Phone:336-608-7411
Mailing Address - Street 1:376 HOLLINSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6245
Mailing Address - Country:US
Mailing Address - Phone:336-608-7411
Mailing Address - Fax:
Practice Address - Street 1:2509A LEWISVILLE CLEMMONS RD # 1004
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8712
Practice Address - Country:US
Practice Address - Phone:336-608-7411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1285876714Medicaid