Jalysa Gavin, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5012334 Issued in NC

Practice address

204 Malloy St Ste a
Goldsboro, NC 27534-4477

Phone

(919) 751-7665

NPI assigned

Sep 26, 2019

Last updated

Sep 26, 2019By the provider in NPPES

Sex

Female

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

Enrolled in NC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Van L. Adams M. D., PLLC

  dba Carolina Internal Medicine and Pediatrics

  • Primary Care Clinic/Center
  • Goldsboro, NC
  • NPI 1124460514
  Medicare reassignment NPD
• Charlotte Radiology P a

  • Specialist
  • Charlotte, NC
  • NPI 1649220443
  NPD (past)

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

{
    "created_epoch": "1569456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569456000000",
    "number": "1972154318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2905 OAKWOOD DR",
            "city": "WINTERVILLE",
            "state": "NC",
            "postal_code": "285908067",
            "telephone_number": "910-441-8652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 MALLOY ST STE A",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275344477",
            "telephone_number": "919-751-7665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAVIN",
        "first_name": "JALYSA",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-26",
        "last_updated": "2019-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5012334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "jgavin.fnp@gmail.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "204 Malloy St Ste A",
            "city": "Goldsboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275344477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mary Carole Gardner
• Lonieka Garner
• Kristin Garrison
• Margarita Gaskill
• Maria Liliana Gausachs
• Uganda Gay
• Kristi Letchworth Geer, RD, MPH
• Hilda Gentry, MSN, RN, FNP-BC
• Chelsea George, D.D.S.
• Courtney Auburn Gerganous, PHARMD

• Family Nurse Practitioner in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.