Individual provider Active NPI

Courtney Nicole Coombe, FNP-BC

  • Nurse Practitioner
  • Mooresville, NC
National Provider Identifier
1104074780
Registry record updated Aug 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5004130 Issued in NC
Practice address
179 Williamson Rd
Mooresville, NC 28117-6831
Phone
(704) 324-3986
NPI assigned
Sep 8, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5004130 NC
Nurse Practitioner 363L00000X 5004130 NC Primary

Addresses

Primary practice location

179 Williamson Rd
Mooresville, NC 28117-6831

Mailing address

PO Box 601843
Charlotte, NC 28260-1843

Other practice location 1

125 Days Inn Dr
Mooresville, NC 28117-6323
Phone (704) 660-9111

Other practice location 2

130 Plantation Ridge Dr Ste 100
Mooresville, NC 28117-9239
Phone (704) 324-3986

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ccoombe1068253@direct.novanthealth.org

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
I20081204000172 NC Practitioner - Nurse Practitioner 4981765310 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolina Medicorp Enterprises LLCGroup PAC ID 0648174904, 184 clinicians

Practice addresses (Care Compare)

179 Williamson Rd
Mooresville, NC 28117-6831
Phone (704) 324-3986

185 Williamson Rd
Mooresville, NC 28117-6831
Phone (844) 266-8268

600 Highland Oaks Dr
Winston Salem, NC 27103-7107
Phone (366) 774-0040

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5004130NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Medicorp Enterprises, LLC CurrentSince Jul 1, 2022 Accepting new patients
Carolina Medicorp Enterprises, LLC CurrentSince Jul 1, 2022 Accepting new patients
Carolina Medicorp Enterprises Inc Past Accepting new patients

Locations

9550 Rocky River Rd
Ste 150
Charlotte, NC 28215
Phone (704) 457-1510

130 Plantation Ridge Dr
Ste 100
Mooresville, NC 28117
Phone (704) 316-1635

600 Highland Oaks Dr
Winston Salem, NC 27103
Phone (366) 774-0040

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": "1220832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722556800000",
    "number": "1104074780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601843",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179 WILLIAMSON RD",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281176831",
            "telephone_number": "704-324-3986"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 Days Inn Dr",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "281176323",
            "country_code": "US",
            "telephone_number": "704-660-9111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 Plantation Ridge Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "281179239",
            "country_code": "US",
            "telephone_number": "704-324-3986",
            "fax_number": "704-324-3990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COOMBE",
        "first_name": "COURTNEY",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-08",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5004130",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5004130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ccoombe1068253@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "179 Williamson Rd",
            "city": "Mooresville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281176831",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mooresville, NC

Sources for this page

Verify at the official NPI Registry.