Provider Demographics
NPI:1992683312
Name:BESPOKE RN, PLLC
Entity type:Organization
Organization Name:BESPOKE RN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO- FOUNDER/NURSE
Authorized Official - Prefix:
Authorized Official - First Name:DANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKOY
Authorized Official - Suffix:
Authorized Official - Credentials:RN- BSN
Authorized Official - Phone:910-228-1215
Mailing Address - Street 1:234 LACEWING DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-0168
Mailing Address - Country:US
Mailing Address - Phone:910-228-1215
Mailing Address - Fax:
Practice Address - Street 1:234 LACEWING DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-0168
Practice Address - Country:US
Practice Address - Phone:910-228-1215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty
No163WS0121XNursing Service ProvidersRegistered NursePlastic SurgeryGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedicGroup - Multi-Specialty