Active NPI
Edna Obehi Idehen, NP
- Family Nurse Practitioner
- Concord, NC
National Provider Identifier
1780170571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 21790
- Practice address
- 101 Cabarrus Ave E
Concord, NC 28025-3699 - Phone
- (888) 849-7379
- Fax
- (855) 857-7333
- NPI assigned
- Jul 5, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 15
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.
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Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lifesource of North CarolinaLifesource Prime Inc
Practice addresses (Care Compare)
3205 Randall Pkwy
Suite 105
Wilmington, NC 28403-2565
Phone (910) 742-9243
939 Springdale Dr
Clinton, SC 29325-7266
Phone (910) 742-9243
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC, SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181102001627 | NC | Practitioner - Nurse Practitioner | 7416200779 | Reassigns benefits to 2 organizations |
| I20190522001844 | SC | Practitioner - Nurse Practitioner | 7416200779 | Reassigns benefits to 4 organizations |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5010620 | NC | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Molina Care Connections, LLC. | Current | Accepting new patients | |
| Capeside Addiction Care, PLLC | Past | Accepting new patients |
Locations
200 Oceangate
Ste 100
Long Beach, CA 90802
Phone (562) 435-3666
4105 Faber Place Dr
Ste 120
North Charleston, SC 29405
Phone (562) 549-3966
Interoperability endpoints
- eidehen16484@direct-prd.molinahealthcare.com
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 21790 | SC | Primary |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 5010620 | NC | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 21790 | SC |
Addresses
Primary practice location
101 Cabarrus Ave E
Concord, NC 28025-3699
Mailing address
101 Cabarrus Ave E
Concord, NC 28025-3699
Phone (888) 849-7379
Other practice location 1
3205 Randall Pkwy Ste 105
Wilmington, NC 28403-2565
Phone (910) 742-9243
Other names 1
- Mrs. Edna Obehi Idehen
NPI Registry JSON
{
"created_epoch": "1530748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774828800000",
"number": "1780170571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 CABARRUS AVE E",
"city": "CONCORD",
"state": "NC",
"postal_code": "280253699",
"telephone_number": "888-849-7379",
"fax_number": "855-857-7333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 CABARRUS AVE E",
"city": "CONCORD",
"state": "NC",
"postal_code": "280253699",
"telephone_number": "888-849-7379",
"fax_number": "855-857-7333"
}
],
"practiceLocations": [
{
"address_1": "3205 Randall Pkwy Ste 105",
"address_purpose": "LOCATION",
"city": "Wilmington",
"state": "NC",
"postal_code": "284032565",
"country_code": "US",
"telephone_number": "910-742-9243",
"fax_number": "888-746-1787",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "IDEHEN",
"first_name": "EDNA",
"middle_name": "OBEHI",
"name_prefix": "Mrs.",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-05",
"last_updated": "2026-03-30",
"certification_date": "2026-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "SC",
"license": "21790",
"primary": true
},
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "NC",
"license": "5010620",
"primary": false
},
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "SC",
"license": "21790",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "EDNA",
"last_name": "IDEHEN",
"middle_name": "OBEHI",
"prefix": "MRS.",
"credential": "NP",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Concord, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2026; 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.