Ryan Bradley Page

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P018399 Issued in NC

Practice address

200 Tarpon TRL
Jacksonville, NC 28546-5287

Phone

(910) 938-1114

Fax

(910) 938-1118

NPI assigned

Oct 28, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• Coastal Carolina Neuropsychiatric Center, PA

  • Psychiatry Physician
  • Jacksonville, NC
  • NPI 1184737462
  NPD (past)

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

{
    "created_epoch": "1666915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1811604002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 TARPON TRL",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465287",
            "telephone_number": "910-938-1114",
            "fax_number": "910-938-1118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 TARPON TRL",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465287",
            "telephone_number": "910-938-1114",
            "fax_number": "910-938-1118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Liberty Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Lumberton",
            "state": "NC",
            "postal_code": "283582446",
            "country_code": "US",
            "telephone_number": "910-938-1114",
            "fax_number": "910-938-1118",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 Fairmont Ct",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283044403",
            "country_code": "US",
            "telephone_number": "910-938-1114",
            "fax_number": "910-938-1118",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "302 Penny Ln",
            "address_purpose": "LOCATION",
            "city": "Morehead City",
            "state": "NC",
            "postal_code": "285574306",
            "country_code": "US",
            "telephone_number": "910-938-1114",
            "fax_number": "910-938-1118",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1630 Military Cutoff Rd Ste 108",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284035719",
            "country_code": "US",
            "telephone_number": "910-938-1114",
            "fax_number": "910-938-1118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAGE",
        "first_name": "RYAN",
        "middle_name": "BRADLEY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-28",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P018399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "credentialing@coastalcarolinapysch.com",
            "affiliation": "N",
            "address_1": "200 Tarpon Trl",
            "city": "Jacksonville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "285465287",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lauren N Pace, PSYD
• Tineka Allynese Pace
• Jomari Pacheco Matos
• Kirie M Paddy, LCSW
• Haley Paganucci
• Kent Titus Painter, RPH
• Palms Wellness Center
• Palms Wellness Center Inc
• Luis Palomino, MD
• Chasity Pappas, ACNP

• Clinical Social Worker in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; 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.