Provider Demographics
NPI:1700022449
Name:HOPSON, LELA MAE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LELA
Middle Name:MAE
Last Name:HOPSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LELA
Other - Middle Name:MAE
Other - Last Name:HOPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:310 PETE JONES DR
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-8180
Mailing Address - Country:US
Mailing Address - Phone:910-324-7268
Mailing Address - Fax:910-324-7273
Practice Address - Street 1:461 WESTERN BLVD STE 122
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7637
Practice Address - Country:US
Practice Address - Phone:248-660-1220
Practice Address - Fax:248-282-5044
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7006000Medicaid
NC7006000Medicaid