NPIMap

Individual provider Active NPI

Phanice Nancy Kebaso, NP

  • Nurse Practitioner
  • Raleigh, NC
National Provider Identifier
1457825820
Registry record updated Feb 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5011436 Issued in NC
Practice address
3000 New Bern Ave
Raleigh, NC 27610-1231
Phone
(919) 350-6835
NPI assigned
Jan 18, 2019
Reactivated
Feb 26, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5011436 NC Primary

Addresses

Primary practice location

3000 New Bern Ave
Raleigh, NC 27610-1231

Mailing address

3000 New Bern Ave
Raleigh, NC 27610-1231

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190402001006 NC Practitioner - Nurse Practitioner 4587905468 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Granville Health SystemGroup PAC ID 1052223757, 78 clinicians
Wakemed Specialists Group LLCGroup PAC ID 2466788377, 868 clinicians

Practice addresses (Care Compare)

101 Manning Dr
Chapel Hill, NC 27514-4220
Phone (984) 974-1000

1010 College St
Oxford, NC 27565-2507
Phone (919) 690-3237

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-7270

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Granville Health System CurrentSince Jun 3, 2024 Accepting new patients
Wakemed Specialists Group, LLC CurrentSince Aug 22, 2019 Accepting new patients
Granville Health System Current Accepting new patients
Wakemed Specialists Group LLC CurrentSince Aug 22, 2019 Accepting new patients
Wakemed Specialists Group, LLC Current Accepting new patients
University of North Carolina at Chapel Hill CurrentSince Apr 2, 2025 Accepting new patients
Granville Health System CurrentSince Jun 3, 2024 Accepting new patients

Locations

1900 Kildaire Farm Rd
Cary, NC 27518
Phone (919) 350-2300

101 Manning Dr
Chapel Hill, NC 27514
Phone (984) 974-1485

5221 Paramount Pkwy
Ste 420
Morrisville, NC 27560
Phone (984) 215-6533

1010 College St
Oxford, NC 27565
Phone (919) 623-5115

10000 Falls of Neuse Rd
Raleigh, NC 27614
Phone (919) 350-1300

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

Interoperability endpoints

  • Direct secure messaging: nkebaso112653@directhisp.wakemed.org

Organizations & group practices 7

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1547769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551225600000",
    "number": "1457825820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 NEW BERN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 NEW BERN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101231",
            "telephone_number": "919-350-6835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEBASO",
        "first_name": "PHANICE",
        "middle_name": "NANCY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-18",
        "last_updated": "2019-02-27",
        "deactivation_date": "2019-02-14",
        "reactivation_date": "2019-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5011436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.