NPIMap

Individual provider Active NPI

Elijah Scott Vernon, FNP-C

  • Family Nurse Practitioner
  • Gastonia, NC
National Provider Identifier
1316539729
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5014104 Issued in NC
Practice address
612 Downey PL
Gastonia, NC 28054-3905
Phone
(704) 689-6944
NPI assigned
Feb 7, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5014104 NC Primary

Addresses

Primary practice location

612 Downey PL
Gastonia, NC 28054-3905

Mailing address

612 Downey PL
Gastonia, NC 28054-3905
Phone (704) 689-6944

Other practice location 1

1771 Tate Blvd SE Ste 10
Hickory, NC 28602-4249
Phone (828) 322-1128

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210412001218 NC Practitioner - Nurse Practitioner 5597173583 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1771 Tate Blvd SE
Suite 103
Hickory, NC 28602-4250
Phone (828) 322-1128

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5014104NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gastonia Physician Services, PLLC CurrentSince Mar 15, 2021 Accepting new patients
Gastonia Physician Services, PLLC Current Accepting new patients
Wake Forest University Health Sciences CurrentSince Jul 12, 2021 Accepting new patients
Gastonia Physician Services, PLLC CurrentSince Mar 15, 2021 Accepting new patients

Locations

2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662

1771 Tate Blvd SE
Ste 103
Hickory, NC 28602
Phone (828) 322-1128

1771 Tate Blvd SE
Ste 10
Hickory, NC 28602
Phone (828) 322-1128

451 E Charlotte Ave
Mt Holly, NC 28120
Phone (980) 834-2266

100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 4

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.

Hospital & facility affiliations 9

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": "1612656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768435200000",
    "number": "1316539729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 DOWNEY PL",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280543905",
            "telephone_number": "704-689-6944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 DOWNEY PL",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280543905",
            "telephone_number": "704-689-6944"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1771 Tate Blvd SE Ste 10",
            "address_purpose": "LOCATION",
            "city": "Hickory",
            "state": "NC",
            "postal_code": "286024249",
            "country_code": "US",
            "telephone_number": "828-322-1128",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VERNON",
        "first_name": "ELIJAH",
        "middle_name": "SCOTT",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-07",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5014104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

Verify at the official NPI Registry.