Individual provider Active NPI

Mabel McCorrison, FNP

  • Nurse Practitioner
  • Boones Mill, VA
National Provider Identifier
1639278690
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
0024166899 Issued in VA
Practice address
22890 Virgil Goode Hwy
Boones Mill, VA 24065
Phone
(540) 344-5511
Fax
(540) 344-3174
NPI assigned
Sep 22, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 0024166899 VA Primary
Family Nurse Practitioner 363LF0000X 0024166899 VA

Addresses

Primary practice location

22890 Virgil Goode Hwy
Boones Mill, VA 24065

Mailing address

213 S Jefferson St Ste 625
Roanoke, VA 24011-1713
Phone (540) 224-5516

Other practice location 1

3745 Holland Rd
Virginia Beach, VA 23452-2847
Phone (757) 962-8720

Other practice location 2

21054A Timberlake Rd
Lynchburg, VA 24502-7327
Phone (434) 239-0627

Other identifiers 2

IdentifierTypeStateIssuer
PENDINGMedicaidVA
1639278690MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070321000217 VA Practitioner - Nurse Practitioner 6800999335 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carilion Giles Community HospitalGroup PAC ID 3678670221, 223 clinicians

Practice addresses (Care Compare)

22890 Virgil Goode Hwy
Boones Mill, VA 24065
Phone (540) 334-5511

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024166899VAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carilion Giles Community Hospital Current Accepting new patients
Carilion Healthcare Corporation CurrentSince Sep 28, 2020 Accepting new patients
Carilion Healthcare Corporation CurrentSince Sep 28, 2020 Accepting new patients
Carilion Giles Community Hospital CurrentSince Sep 28, 2020 Accepting new patients
Carilion Giles Community Hospital CurrentSince Sep 28, 2020 Accepting new patients
Southeastern Emergency Services P C Nurse Practitioner Past Accepting new patients

Locations

159 Hartley Way
Pearisburg, VA 24134
Phone (540) 921-6000

213 S Jefferson St
Ste 625
Roanoke, VA 24011
Phone (540) 224-5677

6415 Peters Creek Rd
Roanoke, VA 24019
Phone (703) 562-2110

Interoperability endpoints

  • Direct secure messaging: mmccorrison129499@direct.carilionclinic.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1639278690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 S JEFFERSON ST STE 625",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240111713",
            "telephone_number": "540-224-5516",
            "fax_number": "540-224-5684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22890 VIRGIL GOODE HWY",
            "city": "BOONES MILL",
            "state": "VA",
            "postal_code": "24065",
            "telephone_number": "540-344-5511",
            "fax_number": "540-344-3174"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3745 Holland Rd",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234522847",
            "country_code": "US",
            "telephone_number": "757-962-8720",
            "fax_number": "757-507-9004",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "21054A Timberlake Rd",
            "address_purpose": "LOCATION",
            "city": "Lynchburg",
            "state": "VA",
            "postal_code": "245027327",
            "country_code": "US",
            "telephone_number": "434-239-0627",
            "fax_number": "434-237-0345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCORRISON",
        "first_name": "MABEL",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-22",
        "last_updated": "2022-07-21",
        "certification_date": "2020-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024166899",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024166899",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639278690",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boones Mill, VA

Sources for this page

Verify at the official NPI Registry.