Coastal Ridge Health Services, PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

0024175505 Issued in VA

Legal business name

COASTAL RIDGE HEALTH SERVICES, PLLC

Practice address

14057 US Highway 17 Ste 200
Hampstead, NC 28443-3793

Phone

(910) 821-1418

Fax

(866) 860-0997

NPI assigned

Aug 10, 2018

Last updated

Jan 11, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Deborah S Jenks, DNP, PMHNP-BC, FNPNPI 1871550491

Title

Owner/Executive Director

Phone

(910) 821-1418

Specialties & licenses 4

Addresses

Other identifiers 3

Other names 1

• Deborah Jenks Former legal business name

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Deborah Sue Jenks, DNP, PMHNP-BC, FNP-C

  • Psychiatric/Mental Health Nurse Practitioner
  • Hampstead, NC
  • NPI 1871550491

  Professional

  Medicare reassignment NPD Authorized official
• Carl Douglas Hurd, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Hampstead, NC
  • NPI 1346914256
  Medicare reassignment NPD
• Christina M Hayden, CNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Willoughby Hills, OH
  • NPI 1053019653

  NC

  Medicare reassignment NPD
• Summer Fischer, LCSWA

  • Clinical Social Worker
  • Hampstead, NC
  • NPI 1326770512
  NPD (past)

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

{
    "created_epoch": "1533859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673395200000",
    "number": "1487133351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14057 US HIGHWAY 17 STE 200",
            "city": "HAMPSTEAD",
            "state": "NC",
            "postal_code": "284433793",
            "telephone_number": "910-821-1418",
            "fax_number": "866-860-0997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14057 US HIGHWAY 17 STE 200",
            "city": "HAMPSTEAD",
            "state": "NC",
            "postal_code": "284433793",
            "telephone_number": "910-821-1418",
            "fax_number": "866-860-0997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL RIDGE HEALTH SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-10",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A",
        "authorized_official_last_name": "JENKS",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "910-821-1418",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP, PMHNP-BC, FNP"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "4461S",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024175505",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "5009986",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH CAROLINA LICENSE NUMBER",
            "identifier": "5009986",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA NP NUMBER",
            "identifier": "0024175505",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH CAROLINA BOARD OF PROFESSIONAL COUNSELORS",
            "identifier": "4461S",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deborah Jenks",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Sarah Coats
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• Samantha Helen Connolly

• Psychiatric/Mental Health Nurse Practitioner in Hampstead, NC
• Providers in Hampstead, NC by specialty
• Psychiatric/Mental Health Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.