Individual provider Active NPI

Kate Danielle Lopez, NP

  • Pediatric Nurse Practitioner
  • Jacksonville, NC
National Provider Identifier
1407511595
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
5017212 Issued in NC
Practice address
120 Memorial Dr
Jacksonville, NC 28546-6328
Phone
(910) 353-0581
Fax
(910) 577-1150
NPI assigned
Nov 3, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 5017212 NC Primary
Pediatric Nurse Practitioner 363LP0200X 383284 NY

Addresses

Primary practice location

120 Memorial Dr
Jacksonville, NC 28546-6328

Mailing address

PO Box 986513
Dept 100
Boston, MA 02298-6513
Phone (910) 219-8326

Other practice location 1

118 Memorial Dr
Jacksonville, NC 28546-6328
Phone (910) 353-0581

Other names 1

  • Kate Danielle Dumain Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NC2 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
I20220104002273 NY Practitioner - Nurse Practitioner 3274924188 Reassigns benefits to 1 organization
I20221212002115 NC Practitioner - Nurse Practitioner 3274924188 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5017212NCMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Dec 10, 2021 Accepting new patients
Amm Healthcare, PA CurrentSince Nov 20, 2022 Accepting new patients
Montefiore Medical Center CurrentSince Dec 10, 2021 Accepting new patients
Jacksonville Behavior and Mental Health CurrentSince Dec 1, 2022 Accepting new patients
Jacksonville Children'S and Multispecialty Clinic, PA CurrentSince Dec 1, 2022 Accepting new patients
Family Care Clinic, P.a. Past Accepting new patients

Locations

114C Memorial Dr
Jacksonville, NC 28546
Phone (910) 346-3976

118 Memorial Dr
Jacksonville, NC 28546
Phone (910) 353-0581

120 Memorial Dr
Jacksonville, NC 28546
Phone (910) 353-0581

111 E 210th St
Bronx, NY 10467

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1635897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1407511595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 986513",
            "address_2": "DEPT 100",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022986513",
            "telephone_number": "910-219-8326",
            "fax_number": "910-939-4269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MEMORIAL DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466328",
            "telephone_number": "910-353-0581",
            "fax_number": "910-577-1150"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "118 Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "NC",
            "postal_code": "285466328",
            "country_code": "US",
            "telephone_number": "910-353-0581",
            "fax_number": "910-353-1351",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "KATE",
        "middle_name": "DANIELLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-03",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5017212",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "383284",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATE",
            "last_name": "DUMAIN",
            "middle_name": "DANIELLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jacksonville, NC

Sources for this page

Verify at the official NPI Registry.