Individual provider Active NPI

Mary Carole Gardner

  • Licensed Practical Nurse
  • Goldsboro, NC
National Provider Identifier
1235898685
Registry record updated Dec 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
87493 Issued in NC
Practice address
1700 E Ash St Ste 201
Goldsboro, NC 27530-4097
Phone
(919) 583-9329
NPI assigned
Dec 14, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 87493 NC Primary

Addresses

Primary practice location

1700 E Ash St Ste 201
Goldsboro, NC 27530-4097

Mailing address

1700 E Ash St Ste 201
Goldsboro, NC 27530-4097
Phone (919) 583-9329

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
87493NCMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Goldsboro CTC CurrentSince Apr 16, 2023 Accepting new patients
Ats of North Carolina, LLC PastSince Dec 21, 2021 Accepting new patients

Locations

1700 E Ash St
Ste 201
Goldsboro, NC 27530
Phone (919) 583-9329

Organizations & group practices 2

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": "1639440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639440000000",
    "number": "1235898685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 E ASH ST STE 201",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275304097",
            "telephone_number": "919-583-9329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 E ASH ST STE 201",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275304097",
            "telephone_number": "919-583-9329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "MARY",
        "middle_name": "CAROLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-14",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NC",
            "license": "87493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goldsboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; 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.