Individual provider Active NPI

Brooke White

  • Speech-Language Pathologist
  • Jacksonville, NC
National Provider Identifier
1508690264
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
30002596 Issued in NC
Practice address
103 N Plain Rd
Jacksonville, NC 28546-6760
Phone
(910) 298-2331
NPI assigned
Aug 27, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 30002596 NC Primary

Addresses

Primary practice location

103 N Plain Rd
Jacksonville, NC 28546-6760

Mailing address

110 E Sea Bird CT
Sneads Ferry, NC 28460-9701

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240925003351 NC Practitioner - Qualified Speech Language Pathologist 6608317094 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coastal Speech Therapy IncGroup PAC ID 5092024323, 7 clinicians

Practice addresses (Care Compare)

124 E Park Dr
Beulaville, NC 28518-6916
Phone (888) 258-6905

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30002596NCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Speech Therapy Inc Speech-Language Pathologist CurrentSince Aug 28, 2024 Accepting new patients

Locations

124 E Park Dr
Beulaville, NC 28518
Phone (888) 258-6905

103 N Plain Rd
Jacksonville, NC 28546
Phone (888) 258-6905

Organizations & group practices 1

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": "1724716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1508690264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E SEA BIRD CT",
            "city": "SNEADS FERRY",
            "state": "NC",
            "postal_code": "284609701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 N PLAIN RD",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466760",
            "telephone_number": "910-298-2331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "BROOKE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-27",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "30002596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.