Provider Demographics
NPI:1942690847
Name:PATRICK, LANESHIA (AGNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LANESHIA
Middle Name:
Last Name:PATRICK
Suffix:
Gender:F
Credentials:AGNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-3219
Mailing Address - Country:US
Mailing Address - Phone:910-353-4878
Mailing Address - Fax:910-353-2258
Practice Address - Street 1:695 S BENNETT ST
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5919
Practice Address - Country:US
Practice Address - Phone:910-725-1708
Practice Address - Fax:910-915-8211
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007434363LP0808X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health