Individual provider Active NPI

Nancy Ann Dartnall, PH.D.

  • Psychologist
  • Gastonia, NC
National Provider Identifier
1346452901
Registry record updated Nov 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
2699 Issued in NC
Practice address
469 Hospital Dr # B
Gastonia, NC 28054-4737
Phone
(704) 833-1294
Fax
(704) 833-1298
NPI assigned
May 4, 2007
Last updated
Nov 18, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 18, 2013

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 2699 NC Primary
Cognitive & Behavioral Psychologist 103TB0200X
Clinical Psychologist 103TC0700X 2699 NC
Intellectual & Developmental Disabilities Psychologist 103TM1800X 2699 NC
Rehabilitation Psychologist 103TR0400X 2699 NC

Addresses

Primary practice location

469 Hospital Dr # B
Gastonia, NC 28054-4737

Mailing address

469 Hospital Dr # B
Gastonia, NC 28054-4737
Phone (704) 833-1294

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140107000005 NC Practitioner - Clinical Psychologist 6507094166 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifesource of North CarolinaGroup PAC ID 7416132428, 172 clinicians

Practice addresses (Care Compare)

3205 Randall Pkwy
Suite 105
Wilmington, NC 28403-2565
Phone (910) 742-9243

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2699NCMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Lifesource of North Carolina Psychologist CurrentSince Nov 15, 2013 Accepting new patients
Lifesource of North Carolina Clinical CurrentSince Nov 15, 2013 Accepting new patients

Locations

3205 Randall Pkwy
Ste 105
Wilmington, NC 28403
Phone (910) 338-2880

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384732800000",
    "number": "1346452901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "469 HOSPITAL DR # B",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280544737",
            "telephone_number": "704-833-1294",
            "fax_number": "704-833-1298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "469 HOSPITAL DR # B",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280544737",
            "telephone_number": "704-833-1294",
            "fax_number": "704-833-1298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DARTNALL",
        "first_name": "NANCY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-04",
        "last_updated": "2013-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "2699",
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "2699",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "NC",
            "license": "2699",
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "NC",
            "license": "2699",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

Verify at the official NPI Registry.