Nicole Grace Fernandez, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

2025-03539 Issued in NC

Practice address

175 Kimel Park Dr Ste 100
Winston Salem, NC 27103-6951

Phone

(336) 718-3550

NPI assigned

May 13, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Psychiatry

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St John'S Episcopal Hospital at South Shore Hospital, Far Rockaway, NY, CCN 330395
• Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722

Interoperability endpoints

• Direct secure messaging: nicole.fernandez.1@14448.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/14448/brand/1/csg/1/fhir/r4

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.

• Forsyth Memorial Hospital, Inc.

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1104548874
  Medicare reassignment Care Compare group
• Novant Health Medical Group, LLC

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  Medicare reassignment
• Forsyth Memorial Hospital, Inc.

  • Psychiatry Physician
  • Winston Salem, NC
  • NPI 1194447805
  NPD
• Forsyth Memorial Hospital, Inc.

  • Cardiovascular Disease Physician
  • Winston Salem, NC
  • NPI 1932935475
  NPD
• Novant Health Medical Group, LLC

  • Obstetrics & Gynecology Physician
  • Matthews, NC
  • NPI 1386506137
  NPD
• Novant Health Medical Group, LLC

  • Psychiatry Physician
  • Huntersville, NC
  • NPI 1588387211
  NPD
• St John'S Medical Services PC

  • Internal Medicine Physician
  • Far Rockaway, NY
  • NPI 1023042173
  NPD

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

• Forsyth Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Winston Salem, NC
  • NPI 1447200233
  Care Compare affiliation

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

{
    "created_epoch": "1557705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768435200000",
    "number": "1477119774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 KIMEL PARK DR STE 100",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036951",
            "telephone_number": "336-718-3550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "327 Beach 19th St",
            "address_purpose": "LOCATION",
            "city": "Far Rockaway",
            "state": "NY",
            "postal_code": "116914423",
            "country_code": "US",
            "telephone_number": "718-869-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "NICOLE",
        "middle_name": "GRACE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-13",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0015X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychosomatic Medicine",
            "state": "NY",
            "license": "330439",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "2025-03539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adolfo Zacarias Fernandez Jr., MD
• Andrea Stephanie Fernandez, MD
• Anna Fernandez, LCSW
• Jairo Omar Fernandez, M.D.
• Luisa Fernandez, PA-C
• Paula Anne Fernandez, M.ED. SLP
• Richard Anthony Fernandez, M.D.
• Rohesh Fernando, M.D.
• Cheyenne Ferner
• Carolyn Ruth Ferree, MD

• Psychiatry Physician in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.