Coltedra SH'Nee Smith, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5012225 Issued in NC

Practice address

2555 Court Dr Ste 450
Gastonia, NC 28054

Phone

(704) 671-7652

Fax

(704) 671-7656

NPI assigned

Aug 31, 2012

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

Other names 1

• Miss Coltedra SH'Nee Ross Former name

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

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Caromont Medical Group IncGroup PAC ID 3577476258, 425 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Caromont Medical Group Inc

  • Family Medicine Physician
  • Gastonia, NC
  • NPI 1356314272
  Medicare reassignment Care Compare group NPD
• Wake Forest Emergency Providers

  • Multi-Specialty Clinic/Center
  • Statesville, NC
  • NPI 1396216735
  Medicare reassignment NPD
• Caromont Medical Group Inc

  dba Ashley Women's Center

  • Obstetrics & Gynecology Physician
  • Gastonia, NC
  • NPI 1679863732
  NPD
• Caromont Medical Group Inc

  • Family Medicine Physician
  • Stanley, NC
  • NPI 1972301380
  NPD

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

{
    "created_epoch": "1346371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606435200000",
    "number": "1336498732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 744786",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303744786",
            "telephone_number": "704-834-2450",
            "fax_number": "704-671-5331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 COURT DR STE 450",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "28054",
            "telephone_number": "704-671-7652",
            "fax_number": "704-671-7656"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "877 Jefferson Ave",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381032807",
            "country_code": "US",
            "telephone_number": "901-545-7857",
            "fax_number": "901-545-7260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "COLTEDRA",
        "middle_name": "SH'NEE",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-31",
        "last_updated": "2020-11-27",
        "certification_date": "2020-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "APN0000016966",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5012225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLTEDRA",
            "last_name": "ROSS",
            "middle_name": "SH'NEE",
            "prefix": "MISS",
            "credential": "FNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Beverlyn Ann Smith, MSW
• Bhanuben Patel Smith, FNP
• Brittany Smith, RBT
• Cecilia Smith, LCMHC
• Cecily Robin Smith, NP
• Courtney Renee Smith, OT
• Dale Smith
• Devon Elizabeth Smith, FNP-C
• Donielle Javontae Smith
• Eva Szentpetery Smith, MD

• Family Nurse Practitioner in Gastonia, NC
• Providers in Gastonia, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.