Carly Anne Peeler Regan, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

5005579 Issued in NC

Practice address

6915 Village Medical Cir
Clemmons, NC 27012-8002

Phone

(336) 718-1680

NPI assigned

Mar 29, 2012

Last updated

Mar 11, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Cornerstone Health Care, PA

  dba Laurel Creek Family Medicine, a Cornerstone Practice

  • Family Medicine Physician
  • Kernersville, NC
  • NPI 1558613901
  NPD (past)
• Laurel Creek Family Medicine, PLLC

  • Family Medicine Physician
  • Kernersville, NC
  • NPI 1487867347
  NPD (past)

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

{
    "created_epoch": "1332979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646956800000",
    "number": "1104192533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "336-718-1680",
            "fax_number": "336-718-1681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6915 VILLAGE MEDICAL CIR",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128002",
            "telephone_number": "336-718-1680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 Old Winston Rd Ste 222",
            "address_purpose": "LOCATION",
            "city": "Kernersville",
            "state": "NC",
            "postal_code": "272849965",
            "country_code": "US",
            "telephone_number": "336-992-1234",
            "fax_number": "336-993-9963",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REGAN",
        "first_name": "CARLY",
        "middle_name": "ANNE PEELER",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-29",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "5005579",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5005579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Purposeful Pediatrics, PLLC
• Vanessa Ann Quentin
• Maria Rakintzaki
• Redmond DDS PLLC
• Kareem Deandre' Redmond, D.D.S.
• Regency Care of Clemmons, LLC (Regency Care of Clemmons)
• Rehab Medicine of the Carolinas PLLC
• Esther Marie Remeta, D.C.
• Restoration Healthcare, PLLC
• Riccobene & Associates I, DDS, P.a. (Riccobene Associates Family Dentistry - Clemmons)

• Nurse Practitioner in Clemmons, NC
• Providers in Clemmons, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.