COASTAL RIDGE HEALTH SERVICES, PLLC (NPI# 1487133351) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487133351 |
| Entity Type | Organization |
| Organization Name | COASTAL RIDGE HEALTH SERVICES, PLLC |
| Other Organization Name | DEBORAH JENKS |
| Practice Address |
18676 Highway 17 N Suite 2 Hampstead NC 28443 |
| Mailing Address |
391 Waldorf Way Hampstead NC 28443-4033 |
| Practice Telephone | 9108211418 |
| Practice Fax Number | 8668600997 |
| Mailing Telephone | 9108211418 |
| Mailing Fax Number | 8668600997 |
| Enumeration Date | 2018-08-10 |
| Last Update Date | 2020-10-29 |
| Authorized Official Name | DR. DEBORAH S JENKS (OWNER/EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 9108211418 |
| Authorized Official Credential | DNP, LPCS, PMHNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YP2500X |
Counselor Specialization: Professional |
4461S | NC | Behavioral Health & Social Service Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
5009986 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
0024175505 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | VIRGINIA NP NUMBER | 0024175505 | 01 |
| NC | NORTH CAROLINA BOARD OF PROFESSIONAL COUNSELORS | 4461S | 01 |
| NC | NORTH CAROLINA LICENSE NUMBER | 5009986 | 01 |
| Other Name | Type Code |
|---|---|
| Deborah Jenks | Former Legal Business Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 13 Cogswood Rd, Asheville, NC 288043803 | 2527236868 | 8668600997 |
| Street Address |
18676 HIGHWAY 17 N SUITE 2 |
| City | HAMPSTEAD |
| State | NC |
| Zip Code | 28443 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871550491 | Deborah Sue Jenks | Counselor | 18676 Highway 17 N, Suite 2, Hampstead, NC 28443-2844 | 2006-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780284745 | Jenean Lacorte | Specialist/Technologist, Other | 18676 Hwy 17 N., Suite 11, Hampstead, NC 28443 | 2020-10-29 |
| 1457966947 | Lauren Paige Nester | Registered Nurse | 113 Pagoda Ct., Hampstead, NC 28443 | 2020-09-10 |
| 1326503657 | Village Pharmacy of Hampstead Inc | Pharmacy | 14057 Hwy 17, Suite 100, Hampstead, NC 28443 | 2019-01-31 |
| 1154896280 | Arbor Landing At Hampstead LLC | Custodial Care Facility | 1397 Us Hwy 17 North, Hampstead, NC 28443 | 2018-10-04 |
| 1134580178 | William Boone | Specialist/Technologist | 106 Katydid Ct, Hampstead, NC 28443 | 2016-03-18 |
| 1679959837 | New River Wellness, Pa | Social Worker | 15444 Us Highway 17 North, Bldg 233, Hampstead, NC 28443 | 2015-08-10 |
| 1932509791 | Laura Behr Jarosz | Physician Assistant | 114 Osier Dr, Hampstead, NC 28443 | 2014-08-29 |
| 1053737064 | Katelyn Braswell | Student in an Organized Health Care Education/Training Program | 309 Knollwood Dr, Hampstead, NC 28443 | 2014-03-14 |
| 1598101826 | Johnson Drug Hampstead Inc. | Pharmacy | 17230 Us Hwy 17n, Suite 222, Hampstead, NC 28443 | 2013-05-14 |
| 1053658302 | James William Boyer | Specialist/Technologist, Other | 1768 Hwy 210, Hampstead, NC 28443 | 2013-01-07 |
| Find all providers in zip 28443 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245751015 | Kelly A Lord | Nurse Practitioner | East Road, Hampstead Hospital, Hampstead, NH 03841 | 2017-07-03 |
| 1255727830 | Serena Verolla, Pllc | Nurse Practitioner | 2 Village Green Rd, Bldg 2 Suite B3, Hampstead, NH 03841-5209 | 2015-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235730078 | Leetisha Lawana Dunia | Nurse Practitioner | 538 Wood Point Dr, Lillington, NC 27546-5971 | 2020-11-06 |
| 1881292134 | Jurell Kirice Riley | Nurse Practitioner | 6301 Dumont Ln, Charlotte, NC 28269-6147 | 2020-10-09 |
| 1336756899 | Jennifer Danks | Nurse Practitioner | 1845 Keener Rd, Clinton, NC 28328-8039 | 2020-09-29 |
| 1376159400 | Ronald Jerome Patterson Jr. | Nurse Practitioner | 4204 Banks Stone Dr, Raleigh, NC 27603-4860 | 2020-09-23 |
| 1902411499 | Solari Mental and Behavioral Health Services | Nurse Practitioner | 11206 Highcrest Dr, Huntersville, NC 28078-0610 | 2020-09-10 |
| 1699389684 | Lasting Hope - Mental Health & Recovery | Nurse Practitioner | 131 Fiddlers Run Blvd, Morganton, NC 28655-0095 | 2020-09-07 |
| 1588277727 | Alison Stroh | Nurse Practitioner | 1313 Banyon Grove Loop, Cary, NC 27513-3936 | 2020-08-27 |
| 1902417488 | Erin Klender Pllc | Nurse Practitioner | 12106 Willingdon Rd, Huntersville, NC 28078-5520 | 2020-08-10 |
| 1407466824 | Theresa Uju Ofoemezie | Nurse Practitioner | 250 S San Agustin Dr, Mooresville, NC 28117-8581 | 2020-08-01 |
| 1669090213 | Rashonda R. Wheeler | Nurse Practitioner | 8949 Cinnabay Dr, Charlotte, NC 28216-2189 | 2020-07-10 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on COASTAL RIDGE HEALTH SERVICES, PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.