Active NPI
Macy Chassereau Medlock
- Certified Registered Nurse Anesthetist
- Winston Salem, NC
National Provider Identifier
1477407963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 382048
- Practice address
- 525 Vine St
Winston Salem, NC 27101-4125 - Phone
- (336) 716-1411
- NPI assigned
- Feb 23, 2026
- Last updated
- Aug 5, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 382048 | NC | Primary |
Addresses
Primary practice location
525 Vine St
Winston Salem, NC 27101-4125
Mailing address
525 Vine St
Winston Salem, NC 27101-4125
Phone (336) 716-1411
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 382048 | NC | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1771804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785888000000",
"number": "1477407963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 VINE ST",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271014125",
"telephone_number": "336-716-1411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 VINE ST",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271014125",
"telephone_number": "336-716-1411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDLOCK",
"first_name": "MACY",
"middle_name": "CHASSEREAU",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-02-23",
"last_updated": "2026-08-05",
"certification_date": "2026-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "NC",
"license": "382048",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.