Individual provider Active NPI

Nicole Deschenes

  • Nurse Practitioner
  • Midland, NC
National Provider Identifier
1316214489
Registry record updated May 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5008521 Issued in NC
Practice address
12925 Highway 601
Suite 300
Midland, NC 28107-9535
Phone
(704) 888-3702
NPI assigned
Nov 17, 2011
Last updated
May 14, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5008521 NC Primary

Addresses

Primary practice location

12925 Highway 601
Suite 300
Midland, NC 28107-9535

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

5641 Poplar Tent Rd
Suite 101
Concord, NC 28027-7533
Phone (704) 512-4808

Other practice location 2

5727 Prosperity Crossing Dr
Suite 2200
Charlotte, NC 28269-2206
Phone (704) 512-4808

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
I20160712002526 NC Practitioner - Nurse Practitioner 6608001268 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Avance Care PAGroup PAC ID 3577634476, 244 clinicians
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

104 Knox CT
Suite 100
Davidson, NC 28036-0590
Phone (704) 892-5454

7482 Waterside Crossing Blvd
Denver, NC 28037-3006
Phone (704) 827-0598

7510 Ramble Way
Suite 107
Raleigh, NC 27616-4305
Phone (919) 747-3033

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5008521NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Avance Care, PA CurrentSince Oct 1, 2023 Accepting new patients

Locations

7510 Ramble Way
Ste 107
Raleigh, NC 27616
Phone (919) 277-8880

Interoperability endpoints

  • Direct secure messaging: ndeschenes35025@fastmed.direct-ci.com
  • Direct secure messaging: nicole.deschenes.1@29681.direct.athenahealth.com

Organizations & group practices 1

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1321488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557792000000",
    "number": "1316214489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12925 HIGHWAY 601",
            "address_2": "SUITE 300",
            "city": "MIDLAND",
            "state": "NC",
            "postal_code": "281079535",
            "telephone_number": "704-888-3702"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5641 Poplar Tent Rd",
            "address_2": "Suite 101",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280277533",
            "country_code": "US",
            "telephone_number": "704-512-4808",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5727 Prosperity Crossing Dr",
            "address_2": "Suite 2200",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282692206",
            "country_code": "US",
            "telephone_number": "704-512-4808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DESCHENES",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-17",
        "last_updated": "2019-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5008521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, NC

Sources for this page

Verify at the official NPI Registry.