Carolina Lab Diagnostics, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

CAROLINA LAB DIAGNOSTICS, LLC

Practice address

632 Springdale Rd
Statesville, NC 28677-3432

Phone

(704) 657-6367

NPI assigned

Mar 8, 2022

Organization subpart

No

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

Authorized official

Name

Jessica Tilley Hicks, NURSE PRACTITIONERNPI 1821675158

Title

Owner

Phone

(704) 657-6367

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jessica Tilley Hicks, FNP

  • Family Nurse Practitioner
  • Statesville, NC
  • NPI 1821675158
  NPD Authorized official

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

{
    "created_epoch": "1646697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646697600000",
    "number": "1093462046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "632 SPRINGDALE RD",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773432",
            "telephone_number": "704-657-6367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "632 SPRINGDALE RD",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773432",
            "telephone_number": "704-657-6367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA LAB DIAGNOSTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-08",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "TILLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-657-6367",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolina Health Professionals Inc
• Carolina Health Professionals, Inc.
• Carolina Health Professionals, Inc.
• Carolina Health Professionals, Inc.
• Carolina Health Proffesionals, Inc.
• Carolina Neurology PA
• Carolina Orthopedics and Sports Medicine Specialists, PA
• Carolina Pain Consultants
• Carolina Psych Group, PA
• Carolina Rehab Incorporation

• Clinical Medical Laboratory in Statesville, NC
• Providers in Statesville, NC by specialty
• Clinical Medical Laboratory in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.