Nicole Annette Hagedorn, D.O.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

78537 Issued in NC

Practice address

2680 Henderson Dr Ste 5
Jacksonville, NC 28546-5297

Phone

(910) 355-0442

Fax

(910) 355-0443

NPI assigned

Jun 22, 2005

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Previously, effective Aug 19, 2020 through Aug 19, 2026

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Coastal Neurotherapy, P.a.

  • Clinical Neuropsychologist
  • Jacksonville, NC
  • NPI 1528353729
  NPD (past)
• Jackson County Memorial Hospital Authority

  • General Acute Care Hospital
  • Altus, OK
  • NPI 1093763781

  Multi-Specialty

  NPD (past)
• Jackson County Memorial Hospital Authority

  • Critical Access Hospital
  • Hollis, OK
  • NPI 1295735991
  NPD (past)

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1619973997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2680 HENDERSON DR STE 5",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465297",
            "telephone_number": "910-355-0442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 HENDERSON DR STE 5",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465297",
            "telephone_number": "910-355-0442",
            "fax_number": "910-355-0443"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Valencia Dr",
            "address_2": "Suite 109",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "NC",
            "postal_code": "285466311",
            "country_code": "US",
            "telephone_number": "580-471-6664",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAGEDORN",
        "first_name": "NICOLE",
        "middle_name": "ANNETTE",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-22",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NC",
            "license": "78537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles Grayson Guyer, EDD
• Erica Haberland
• Hampton D Hadley, DC
• Edward Wayne Haga, M.D.
• Daniel M Hagan, DPM
• Danielle Haines
• Amy Rose Hall, PSY.D.
• Lori Hall, LDO
• Wesley James Hall, PT, DPT
• Arlene Hallegado, M.D.

• Obstetrics & Gynecology Physician in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Obstetrics & Gynecology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.