Shore Fun Pediatrics

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

SHORE FUN PEDIATRICS

Practice address

14 Doctors Cir
Suite 3
Supply, NC 28462-4097

Phone

(910) 754-7075

Fax

(910) 754-2158

NPI assigned

Feb 6, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Brucie Janelle Spivey-Cochran

Title

Practice Manager

Phone

(910) 754-7075

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rachel Irving Almond, FNP-BC

  • Family Nurse Practitioner
  • Shallotte, NC
  • NPI 1003106956
  NPD (past)
• Mary Beth Barna, PNP-BC

  • Pediatric Nurse Practitioner
  • Supply, NC
  • NPI 1255765095
  NPD (past)
• Susan Marie Brandt, FNP

  • Primary Care Nurse Practitioner
  • Wilmington, NC
  • NPI 1801945837
  NPD (past)
• Erin Riley Graves, FNP

  • Nurse Practitioner
  • Wilmington, NC
  • NPI 1891233516
  NPD (past)
• Emili Rachele Mack, MD

  • Pediatrics Physician
  • Raleigh, NC
  • NPI 1184618019
  NPD (past)
• Crystal Dawn Murphy, C-PNP

  • Pediatric Nurse Practitioner
  • Supply, NC
  • NPI 1639403421
  NPD (past)
• Joanne Peck, MD

  • Pediatrics Physician
  • Supply, NC
  • NPI 1790797108
  NPD (past)
• Alicia Hope Tyndall, FNP-BC

  • Family Nurse Practitioner
  • Supply, NC
  • NPI 1134131584
  NPD (past)
• Sierra K Vogel, PA-C

  • Physician Assistant
  • Carolina Beach, NC
  • NPI 1730921602
  NPD (past)
• Katherine J Waldrop

  • Mental Health Counselor
  • Shallotte, NC
  • NPI 1336498229
  NPD (past)

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750420428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 DOCTORS CIR",
            "address_2": "SUITE 3",
            "city": "SUPPLY",
            "state": "NC",
            "postal_code": "284624097",
            "telephone_number": "910-754-7075",
            "fax_number": "910-754-2158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 DOCTORS CIR",
            "address_2": "SUITE 3",
            "city": "SUPPLY",
            "state": "NC",
            "postal_code": "284624097",
            "telephone_number": "910-754-7075",
            "fax_number": "910-754-2158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE FUN PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SPIVEY-COCHRAN",
        "authorized_official_first_name": "BRUCIE",
        "authorized_official_middle_name": "JANELLE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "910-754-7075",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kirsten M Schneider, PA-C
• Jeffrey D Seder, M.D.
• Shallotte Medical Center Inc (Holden Beach Medical Center)
• Loretta Maree Shannon, OTR/L
• Renee Elizabeth Shepherd-Smith, DPM
• South Atlantic Radiation Oncology, LLC
• Southern Cross Community Services, Inc (Southern Cross Mental Health Centers)
• Daniel B Spagnoli, DDS, MS, PHD
• Specialty Eye Care of the Carolinas, PC
• Kendra Spencer, LCSWA, LCASA

• Pediatrics Physician in Supply, NC
• Providers in Supply, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.