Individual provider Active NPI

Ryan Dague, DNP FNP-BC

  • Family Nurse Practitioner
  • Wilson, NC
National Provider Identifier
1801501630
Registry record updated May 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5022226 Issued in NC
Practice address
4701 International Blvd
Wilson, NC 27893-9664
Phone
(252) 265-1957
NPI assigned
Jan 17, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APN.27251 SC
Family Nurse Practitioner 363LF0000X RN275020 GA
Family Nurse Practitioner 363LF0000X 5022226 NC Primary

Addresses

Primary practice location

4701 International Blvd
Wilson, NC 27893-9664

Mailing address

4701 International Blvd
Wilson, NC 27893-9664

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC2 enrollments
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230728000026 GA Practitioner - Nurse Practitioner 9739540477
I20231010002397 SC Practitioner - Nurse Practitioner 9739540477 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5022226NCMDFamily Nurse Practitioner
APN.27251SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Minuteclinic Video Virtual Care, PLLC Family CurrentSince Aug 29, 2023 Accepting new patients
Premise Health of North Carolina Medical PC CurrentSince Sep 8, 2025 Accepting new patients

Locations

4701 International Blvd
Wilson, NC 27893
Phone (252) 265-1957

101 Edgefield Rd
North Augusta, SC 29841
Phone (803) 279-7470

698 Fairview Rd
Simpsonville, SC 29680
Phone (864) 962-8991

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1673913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748390400000",
    "number": "1801501630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 INTERNATIONAL BLVD",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278939664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 INTERNATIONAL BLVD",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278939664",
            "telephone_number": "252-265-1957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAGUE",
        "first_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "DNP FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-17",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "APN.27251",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN275020",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5022226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilson, NC

Sources for this page

Verify at the official NPI Registry.