NPIMap

Organization Active NPI

Complexion Medical Spa PLLC

  • Family Nurse Practitioner
  • Atlantic Beach, NC
National Provider Identifier
1346955895
Registry record updated Mar 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
COMPLEXION MEDICAL SPA PLLC
Practice address
201 W Fort Macon Rd
Atlantic Beach, NC 28512-5303
Phone
(252) 773-0841
Fax
(252) 773-0737
NPI assigned
Jan 19, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2023

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

Authorized official

Name
Ms. Cassandra Davis, FNP-BCNPI 1073937397
Title
DNP, FNP-BC
Phone
(252) 725-3844

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

201 W Fort Macon Rd
Atlantic Beach, NC 28512-5303

Mailing address

201 W Fort Macon Rd
Atlantic Beach, NC 28512-5303
Phone (252) 773-0841

Other names 1

  • Complexion Med Spa and Aesthetics Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230611000234 NC Part B Supplier - Clinic/Group Practice 4082071709 Receives reassigned benefits from 1 practitioner
Practice locations: Atlantic Beach, NC

National Provider Directory

National Provider Directory

Locations

201 W Fort Macon Rd
Atlantic Beach, NC 28512
Phone (252) 773-0841

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1674086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679270400000",
    "number": "1346955895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W FORT MACON RD",
            "city": "ATLANTIC BEACH",
            "state": "NC",
            "postal_code": "285125303",
            "telephone_number": "252-773-0841",
            "fax_number": "252-773-0737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W FORT MACON RD",
            "city": "ATLANTIC BEACH",
            "state": "NC",
            "postal_code": "285125303",
            "telephone_number": "252-773-0841",
            "fax_number": "252-773-0737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLEXION MEDICAL SPA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-19",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_title_or_position": "DNP, FNP-BC",
        "authorized_official_telephone_number": "252-725-3844",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Complexion Med Spa and Aesthetics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Complexion Med Spa and Aesthetics",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Complexion Med Spa and Aesthetics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Atlantic Beach, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.