Jennifer Nicole Brennan, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

5017058 Issued in NC

Practice address

112 Medical Village Dr Ste G
Wallace, NC 28466-1665

Phone

(910) 552-1580

NPI assigned

Oct 10, 2022

Last updated

Oct 18, 2022By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wallace Urgent Care LLCGroup PAC ID 6709967912, 8 clinicians

Sandy Shores Medical Center and Urgent CareGroup PAC ID 1658787270, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Sandy Shores Medical Center and Urgent Care

  • Urgent Care Clinic/Center
  • Surf City, NC
  • NPI 1821681271
  Medicare reassignment Care Compare group NPD
• Wallace Urgent Care LLC

  • Internal Medicine Physician
  • Wallace, NC
  • NPI 1841259025

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Urgent Care of Wallace, PLLC

  • Urgent Care Clinic/Center
  • Wallace, NC
  • NPI 1699372243
  Medicare reassignment NPD
• Sandy Shores Primary Care, PLLC

  • Primary Care Clinic/Center
  • Surf City, NC
  • NPI 1508511767
  NPD

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

{
    "created_epoch": "1665360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1730804907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 PAGODA CT",
            "city": "HAMPSTEAD",
            "state": "NC",
            "postal_code": "284437252",
            "telephone_number": "571-643-3195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 MEDICAL VILLAGE DR STE G",
            "city": "WALLACE",
            "state": "NC",
            "postal_code": "284661665",
            "telephone_number": "910-552-1580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENNAN",
        "first_name": "JENNIFER",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-10",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5017058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blair Family Medicine
• Mott Parks Blair IV, M.D.
• Joseph Bologna, D.M.D.
• Angela Boney, PHARMD
• Kathryn Elizabeth Rand Booher, DPT
• Erika Houston Brown, O.D.
• Brittany Byrd, PHARMD
• Carolina Healthcare Associates Inc (Wallace Urgent Care)
• Carolina Residential Services, Inc.
• Carolina Residential Services, Inc.

• Nurse Practitioner in Wallace, NC
• Providers in Wallace, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.
• 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.