Individual provider Active NPI

Leah Christine Fitzgerald, FNP-BC

  • Family Nurse Practitioner
  • Jacksonville, NC
National Provider Identifier
1043987852
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5015134 Issued in NC
Practice address
114A Memorial Dr
Jacksonville, NC 28546-6328
Phone
(910) 353-0700
Fax
(910) 353-5305
NPI assigned
Aug 28, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X FITZ-17X2Y NC
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 5015134 NC Primary

Addresses

Primary practice location

114A Memorial Dr
Jacksonville, NC 28546-6328

Mailing address

PO Box 986513
Boston, MA 02298-6513
Phone (910) 219-8326

Other practice location 1

Clinic #5313
13304 Leesville Church Road
Raleigh, NC 28617
Phone (919) 845-5276

Other practice location 2

1106 Main Street Ext
Swansboro, NC 28584-9114
Phone (910) 325-0581

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211209000760 NC Practitioner - Nurse Practitioner 6204226038 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5015134NCMDFamily Nurse Practitioner
FITZ-17X2YNCMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jacksonville Children'S and Multispecialty Clinic, PA Multi-Specialty CurrentSince Aug 3, 2022 Accepting new patients
Amm Healthcare, PA Multi-Specialty CurrentSince Nov 6, 2022 Accepting new patients
Family Care Clinic, P.a. Multi-Specialty Past Accepting new patients

Locations

114C Memorial Dr
Jacksonville, NC 28546
Phone (910) 346-3976

114A Memorial Dr
Jacksonville, NC 28546
Phone (910) 353-0700

120 Memorial Dr
Jacksonville, NC 28546
Phone (910) 353-0581

1106 Main Street Ext
Swansboro, NC 28584
Phone (910) 325-0581

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1043987852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 986513",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022986513",
            "telephone_number": "910-219-8326",
            "fax_number": "910-939-4269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114A MEMORIAL DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466328",
            "telephone_number": "910-353-0700",
            "fax_number": "910-353-5305"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Clinic #5313",
            "address_2": "13304 Leesville Church Road",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "28617",
            "country_code": "US",
            "telephone_number": "919-845-5276",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1106 Main Street Ext",
            "address_purpose": "LOCATION",
            "city": "Swansboro",
            "state": "NC",
            "postal_code": "285849114",
            "country_code": "US",
            "telephone_number": "910-325-0581",
            "fax_number": "910-325-0582",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "LEAH",
        "middle_name": "CHRISTINE",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-28",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NC",
            "license": "FITZ-17X2Y",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5015134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, NC

Sources for this page

Verify at the official NPI Registry.