Individual provider Active NPI

Carey Lauren Holloway Douglas, NP-C

  • Family Nurse Practitioner
  • Enterprise, AL
National Provider Identifier
1922430602
Registry record updated Sep 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1-125453 Issued in AL
Practice address
101 Professional LN
Enterprise, AL 36330-2085
Phone
(334) 347-3404
Fax
(334) 393-0613
NPI assigned
Aug 5, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1-125453 AL Primary

Addresses

Primary practice location

101 Professional LN
Enterprise, AL 36330-2085

Mailing address

PO Box 1928
Dothan, AL 36302-1928
Phone (334) 793-8087

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130823000683 AL Practitioner - Nurse Practitioner 1355584392 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

101 Professional LN
Enterprise, AL 36330-2085
Phone (334) 347-3404

1108 Ross Clark Cir
Dothan, AL 36301-3022
Phone (334) 793-8087

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1-125453ALMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Houston County Healthcare Authority Current Accepting new patients
Houston County Healthcare Authority Current Accepting new patients
Houston County Healthcare Authority CurrentSince Aug 1, 2016 Accepting new patients
Pathology Laboratory Associates Current Accepting new patients
Medcore Associates, PLLC Current Accepting new patients
Houston County Healthcare Authority Current Accepting new patients
Southeast Alabama Medical Center Employee Pharmacy Past Accepting new patients

Locations

1108 Ross Clark Cir
Dothan, AL 36301
Phone (334) 712-3635

1118 Ross Clark Cir
Ste 500
Dothan, AL 36301
Phone (334) 794-4159

101 Professional Ln
Enterprise, AL 36330
Phone (334) 347-3404

Interoperability endpoints

  • Direct secure messaging: cdouglas12315@southeasthealth.direct-ci.com

Organizations & group practices 7

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1375660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474934400000",
    "number": "1922430602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1928",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363021928",
            "telephone_number": "334-793-8087",
            "fax_number": "334-793-8191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PROFESSIONAL LN",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363302085",
            "telephone_number": "334-347-3404",
            "fax_number": "334-393-0613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLOWAY DOUGLAS",
        "first_name": "CAREY",
        "middle_name": "LAUREN",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-05",
        "last_updated": "2016-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-125453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Enterprise, AL

Sources for this page

Verify at the official NPI Registry.