Community Care Clinic of Dare

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

COMMUNITY CARE CLINIC OF DARE

Practice address

425 W Health Center Dr
Nags Head, NC 27959-8944

Phone

(252) 261-3041

Fax

(252) 255-6352

NPI assigned

Jun 14, 2022

Organization subpart

No

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

Authorized official

Name

Mrs. Lyn Mathis Jenkins, BSN RN

Title

Executive Director

Phone

(252) 261-3041

Specialties & licenses 2

Addresses

Tax ID family

Community Care Clinic of Dare2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Community Care Clinic of Dare

  • Clinic Pharmacy
  • Nags Head, NC
  • NPI 1013631068
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Community Care Clinic of Dare

  • Clinic Pharmacy
  • Nags Head, NC
  • NPI 1013631068
  NPPES parent name

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Leslie Schmidt Deligio, DNP, FNP-C

  • Family Nurse Practitioner
  • Nags Head, NC
  • NPI 1598719163
  NPD
• Whitney Lynn Edwards

  • Family Nurse Practitioner
  • Nags Head, NC
  • NPI 1295583425
  NPD
• Karen Reeder, BSPHARM, RPH

  • Pharmacist
  • Nags Head, NC
  • NPI 1851752141
  NPD
• Michelle Paris Petty, DNP-FNP

  • Family Nurse Practitioner
  • Frisco, NC
  • NPI 1699497107
  NPD (past)

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

{
    "created_epoch": "1655164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660176000000",
    "number": "1942930748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1329",
            "city": "NAGS HEAD",
            "state": "NC",
            "postal_code": "279591329",
            "telephone_number": "252-261-3041",
            "fax_number": "252-255-6352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W HEALTH CENTER DR",
            "city": "NAGS HEAD",
            "state": "NC",
            "postal_code": "279598944",
            "telephone_number": "252-261-3041",
            "fax_number": "252-255-6352"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50347 NC HWY 12",
            "address_purpose": "LOCATION",
            "city": "FRISCO",
            "state": "NC",
            "postal_code": "279362795",
            "country_code": "US",
            "telephone_number": "252-261-3041",
            "fax_number": "252-255-6352",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COMMUNITY CARE CLINIC OF DARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-14",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "LYN",
        "authorized_official_middle_name": "MATHIS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "252-261-3041",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BSN RN"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• CNC/Access, Inc.
• CNC/Access, Inc.
• Coastal Eyes of the Outer Banks PLLC
• Christine Coleman, NP
• Community Care Clinic of Dare
• Continuum II Home Health & Hospice, Inc.
• Croatan Family Medicine, P.C.
• Jill Ann Curry, MA, LCMHCA, NCC
• Dare County Schools
• Denise Elaine De Pedro, NBC-HWC

• General Practice Physician in Nags Head, NC
• Providers in Nags Head, NC by specialty
• General Practice Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 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.