Provider Demographics
NPI:1194525857
Name:FAKAYODE, ESTHER (NURSE PRACTIONER)
Entity type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:
Last Name:FAKAYODE
Suffix:
Gender:
Credentials:NURSE PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 BOYER DR
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8856
Mailing Address - Country:US
Mailing Address - Phone:336-682-3565
Mailing Address - Fax:
Practice Address - Street 1:850 BOYER DR
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8856
Practice Address - Country:US
Practice Address - Phone:336-682-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC244578364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health