Theresa McNeill Carmon
Individual provider Active NPI Family Nurse Practitioner · Wake Forest, NC
NPI 1336078658 · NPPES record last updated Jun 20, 2026
Key facts
- NPI
- 1336078658
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 5024536 (NC)
- Practice address
- 2115 S Main St Ste a
Wake Forest, NC 27587-5011 - Phone
- (919) 229-4833
- NPI assigned
- May 14, 2026
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mainstreet and Kidsstreet of North Carolina PLLC
Practice addresses (Care Compare)
130 James Ave
Locust, NC 28097-4506
Phone (704) 296-4508
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260605000974 | NC | Practitioner - Nurse Practitioner | 1254802754 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F02260905 | NC | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 5024536 | NC | Yes |
Addresses
Primary practice location
2115 S Main St Ste a
Wake Forest, NC 27587-5011
Mailing address
1500 1St Ave N Unit 3
Birmingham, AL 35203-1866
Other providers in Wake Forest, NC
- Andrea Renee Capranos
- Care Services on Call
- Carillon Assisted Living of Wake Forest LLC
- Caring Connections Pediatric Therapy PLLC
- Catherine Carmon
- Carolina Chiropractic and Consulting PLLC
- Carolina Concussion & Physical Medicine, PLLC
- Carolina Diagnostics Inc
- Carolina Diagnostics, Inc
- Carolina Learn and Play LLC
All providers in Wake Forest, NC · Family Nurse Practitioner in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.