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NPI Code Detail

MEDICARE: COASTAL RIDGE HEALTH SERVICES, PLLC

MEDICARE: COASTAL RIDGE HEALTH SERVICES, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner
2363LP0808XPsychiatric/Mental Health Nurse Practitioner5009986NC
3101YP2500XProfessional Counselor4461SNC
4363LP0808XPsychiatric/Mental Health Nurse Practitioner0024175505VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10024175505OTHERVAVIRGINIA NP NUMBER
24461SOTHERNCNORTH CAROLINA BOARD OF PROFESSIONAL COUNSELORS
35009986OTHERNCNORTH CAROLINA LICENSE NUMBER

General Provider Information

NPI Number : 1487133351
Entity Type Code : Organization
Provider Name (Legal Business Name) : COASTAL RIDGE HEALTH SERVICES, PLLC
Provider Business Mailing Address
First Line : 14057 US HIGHWAY 17 STE 200
Second Line :
City : HAMPSTEAD
State : NC
Zip : 28443-3793
Country : US
Telephone Number : 910-821-1418
Fax Number : 866-860-0997
Provider Business Practice Location Address
First Line : 14057 US HIGHWAY 17 STE 200
Second Line :
City : HAMPSTEAD
State : NC
Zip : 28443-3793
Country : US
Telephone Number : 910-821-1418
Fax Number : 866-860-0997
Authorized Official
Title or Position : OWNER/EXECUTIVE DIRECTOR
Name : DR. DEBORAH S JENKS
Credential : DNP, PMHNP-BC, FNP
Telephone Number : 910-821-1418
Provider Enumeration Date : 08/10/2018
Last Update Date : 01/11/2023

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