Provider Demographics
NPI:1588426498
Name:SMITH, SHEEKETA BELLAMY
Entity type:Individual
Prefix:
First Name:SHEEKETA
Middle Name:BELLAMY
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 N JK POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3008
Mailing Address - Country:US
Mailing Address - Phone:910-640-2009
Mailing Address - Fax:
Practice Address - Street 1:614 N JK POWELL BLVD
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3008
Practice Address - Country:US
Practice Address - Phone:910-640-2009
Practice Address - Fax:910-640-3036
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019507363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner