Basic Information
| Provider Information | |||||||||
| NPI: | 1841402161 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRICE | ||||||||
| FirstName: | NERISSA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 JONES FRANKLIN RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276063374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198525265 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 JONES FRANKLIN RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276063374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198525265 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 06/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 2006-00837 | NC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 5904860 | 05 | NC | MEDICAID |