Angelica Formo Keech, WHNP-BC,NP-C
Individual provider Active NPI Adult Health Nurse Practitioner · Plymouth, NC
NPI 1902247299 · NPPES record last updated Feb 28, 2024
Key facts
- NPI
- 1902247299
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- 5006257 (NC)
- Practice address
- 198 Hwy 45 North
Plymouth, NC 27962 - Phone
- (252) 793-3023
- Fax
- (252) 791-3108
- NPI assigned
- Jul 15, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150129001656 | NC | Practitioner - Nurse Practitioner | 1759605454 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5006257 | NC | MD | Women's Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| East Carolina Anesthesia Associates, PLLC | Current |
Accepting new patients | |
| Curana Health of North Carolina PLLC | Current |
Accepting new patients | |
| Physicians Eldercare PA | Current |
Accepting new patients | |
| Martin Tyrrell Washington District Health Department | Past | Accepting new patients |
Locations
2430 Emerald Pl
Ste 103
Greenville, NC 27834
Phone (252) 752-2140
4692 Brownsboro Rd
Winston Salem, NC 27106
Phone (336) 251-1114
Interoperability endpoints
- angelica.keech@direct.mtwdhhealth.nchie.net
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | 5006257 | NC | |
| Adult Health Nurse Practitioner | 363LA2200X | 5006257 | NC | Yes |
Addresses
Primary practice location
198 Hwy 45 North
Plymouth, NC 27962
Mailing address
933 Louise Ave
Charlotte, NC 28204-2147
Phone (844) 866-1866
Other providers in Plymouth, NC
- Interim Healthcare - Morris Group Inc
- Interim Healthcare - Morris Group Inc
- Mable Norman James
- Angie Kay Jarrell
- Myung Kil Jeon
- Kerr Drug Inc
- Key of Life Counseling Services PLLC
- Kinder Care Family Home Care LLC
- Tempie Phelps Lancaster
- Richard Whitfield Leggett
All providers in Plymouth, NC · Adult Health Nurse Practitioner in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.