Sandra R Farrelly, RN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5004023 Issued in NC

Practice address

196 S Trade St
Matthews, NC 28105-5772

Phone

(704) 841-8882

NPI assigned

May 29, 2008

Last updated

Sep 27, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• McAdams Free Clinic

  • Clinic/Center
  • Matthews, NC
  • NPI 1578851960
  NPD (past)

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

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474934400000",
    "number": "1699933309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 S TRADE ST",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281055772",
            "telephone_number": "704-841-8882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 S TRADE ST",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281055772",
            "telephone_number": "704-841-8882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARRELLY",
        "first_name": "SANDRA",
        "middle_name": "R",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-29",
        "last_updated": "2016-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5004023",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "75437",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7004174",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP1263",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evergrace Home Care LLC
• Shelley Jane Everts, FNP
• Stephen James Ezzo, M.D,
• Derek Farmen
• Edith Ann Farr, APRN
• Olukayode Fasuba
• Zayd Fattah
• Jessica Lynn Faulk
• Tarah Faust, PTA
• FBTC Transitional Sub, LLC (Bright Light)

• Family Nurse Practitioner in Matthews, NC
• Providers in Matthews, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.