Active NPI
Annie Phan
- Nurse Practitioner
- Lillington, NC
National Provider Identifier
1003617184
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 5021862
- Practice address
- 130 Pine State St Ste C
Lillington, NC 27546-9414 - Phone
- (910) 474-0050
- NPI assigned
- Mar 24, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 5021862 | NC | Primary |
Addresses
Primary practice location
130 Pine State St Ste C
Lillington, NC 27546-9414
Mailing address
130 Pine State St Ste C
Lillington, NC 27546-9414
Phone (910) 474-0050
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250818004539 | NC | Practitioner - Nurse Practitioner | 1951800705 |
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
130 Pine State St
Suite C
Lillington, NC 27546-8415
304 Montvale CT
Apex, NC 27502-4009
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5021862 | NC | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1742774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752796800000",
"number": "1003617184",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 PINE STATE ST STE C",
"city": "LILLINGTON",
"state": "NC",
"postal_code": "275469414",
"telephone_number": "910-474-0050",
"fax_number": "863-228-8484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 PINE STATE ST STE C",
"city": "LILLINGTON",
"state": "NC",
"postal_code": "275469414",
"telephone_number": "910-474-0050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "ANNIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-03-24",
"last_updated": "2025-07-18",
"certification_date": "2025-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NC",
"license": "5021862",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lillington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.