Individual provider Active NPI

Maggie Whitt Mazurek, FNP-C

  • Psychiatric/Mental Health Nurse Practitioner
  • Indian Trail, NC
National Provider Identifier
1376968487
Registry record updated Sep 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
5007328 Issued in NC
Practice address
1150 Hawthorne Dr
Indian Trail, NC 28079-4135
Phone
(980) 999-0466
Fax
(704) 704-1053
NPI assigned
Feb 26, 2014
Last updated
Sep 30, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2026

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 246723 NC
Family Nurse Practitioner 363LF0000X 5007328 NC
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 5007328 NC Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 24007 SC
Psychiatric/Mental Health Nurse Practitioner 363LP0808X C-APN.0107911-C-NP CO

Addresses

Primary practice location

1150 Hawthorne Dr
Indian Trail, NC 28079-4135

Mailing address

1150 Hawthorne Dr
Indian Trail, NC 28079-4135
Phone (980) 999-0466

Other practice location 1

2261 Market St Ste 10222
San Francisco, CA 94114-1612
Phone (415) 360-3348

Other practice location 2

1500 N Grant St Ste N
Denver, CO 80203-1859
Phone (980) 999-1053

Other names 1

  • Maggie Lauren Whitt Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150127000563 NC Practitioner - Nurse Practitioner 2466675822 Reassigns benefits to 2 organizations
I20220419002986 SC Practitioner - Nurse Practitioner 2466675822

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
246723NCMDFamily Nurse Practitioner
C-APN.0107911-C-NPCOMDPsychiatric/Mental Health Nurse Practitioner
5007328NCMDPsychiatric/Mental Health Nurse Practitioner
95000436CAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Minuteclinic Diagnostic of North Carolina PC Family CurrentSince Dec 7, 2014 Accepting new patients
Lifesource of North Carolina Nurse Practitioner CurrentSince Feb 1, 2022 Accepting new patients
Lifesource of North Carolina Nurse Practitioner CurrentSince Feb 1, 2022 Accepting new patients
Lifesource of North Carolina Nurse Practitioner CurrentSince Apr 6, 2022 Accepting new patients

Locations

6840 Glenwood Ave
Raleigh, NC 27612
Phone (401) 770-4415

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

1915 Ebenezer Rd
Rock Hill, SC 29732
Phone (305) 866-9951

Organizations & group practices 5

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": "1393372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790726400000",
    "number": "1376968487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 HAWTHORNE DR",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280794135",
            "telephone_number": "980-999-0466",
            "fax_number": "704-704-1053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 HAWTHORNE DR",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280794135",
            "telephone_number": "980-999-0466",
            "fax_number": "704-704-1053"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2261 Market St Ste 10222",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941141612",
            "country_code": "US",
            "telephone_number": "415-360-3348",
            "fax_number": "704-704-1053",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 N Grant St Ste N",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802031859",
            "country_code": "US",
            "telephone_number": "980-999-1053",
            "fax_number": "704-704-1053",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAZUREK",
        "first_name": "MAGGIE",
        "middle_name": "WHITT",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-26",
        "last_updated": "2026-09-30",
        "certification_date": "2026-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "246723",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5007328",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "5007328",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "SC",
            "license": "24007",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CO",
            "license": "C-APN.0107911-C-NP",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAGGIE",
            "last_name": "WHITT",
            "middle_name": "LAUREN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Indian Trail, NC

Sources for this page

Verify at the official NPI Registry.