Provider Demographics
NPI:1427319698
Name:FOUSHEE, JACQUETTA MELONY (MD)
Entity type:Individual
Prefix:
First Name:JACQUETTA
Middle Name:MELONY
Last Name:FOUSHEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SUNDAY DR
Mailing Address - Street 2:STE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-5151
Mailing Address - Country:US
Mailing Address - Phone:919-322-2413
Mailing Address - Fax:919-322-2416
Practice Address - Street 1:1500 SUNDAY DR
Practice Address - Street 2:STE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5151
Practice Address - Country:US
Practice Address - Phone:919-322-2413
Practice Address - Fax:919-322-2416
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2018-015382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program