| Capeside Psychiatry, Pllc | |
|
311 Judges Rd Ste 4e Wilmington NC 28405-3655 | |
| (910) 791-6767 | |
| Not Available |
| Full Name | Capeside Psychiatry, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 311 Judges Rd Ste 4e, Wilmington, North Carolina |
| Authorized Official Name and Position | Amanda Nicole Dockery (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 8283616739 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Capeside Psychiatry, Pllc 311 Judges Rd Ste 4e Wilmington NC 28405-3655 Ph: (910) 791-6767 | Capeside Psychiatry, Pllc 311 Judges Rd Ste 4e Wilmington NC 28405-3655 Ph: (910) 791-6767 |
| NPI Number | 1760891980 |
|---|---|
| Provider Enumeration Date | 08/13/2014 |
| Last Update Date | 02/27/2023 |
| Certification Date | 02/27/2023 |
| Medicare PECOS PAC ID | 5991926560 |
|---|---|
| Medicare Enrollment ID | O20141023001370 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760891980 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | Barry Allen Moore |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255323622 PECOS PAC ID: 4183536303 Enrollment ID: I20031105000116 |
| Provider Name | Tamara L Starr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619995982 PECOS PAC ID: 5799758926 Enrollment ID: I20040817000118 |
| Provider Name | Donna Hensley Beck |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932407806 PECOS PAC ID: 8628251584 Enrollment ID: I20110330000648 |
| Provider Name | Meghan Blankmann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205173911 PECOS PAC ID: 0749421493 Enrollment ID: I20130723000951 |
| Provider Name | Robert Faulkner |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1437105665 PECOS PAC ID: 7517863517 Enrollment ID: I20131204001298 |
| Provider Name | Sara V Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992118905 PECOS PAC ID: 5698996494 Enrollment ID: I20141020002717 |
| Provider Name | Kelly Wilkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275819617 PECOS PAC ID: 1951626308 Enrollment ID: I20150206001204 |
| Provider Name | Travis Bo Money |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225419625 PECOS PAC ID: 0648573204 Enrollment ID: I20160502000124 |
| Provider Name | Soni Anil |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023441565 PECOS PAC ID: 0042448706 Enrollment ID: I20180123001222 |
| Provider Name | Bamidele Odede |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831693357 PECOS PAC ID: 4789939752 Enrollment ID: I20180614001817 |
| Provider Name | Crystal P Beddard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295090801 PECOS PAC ID: 1951552355 Enrollment ID: I20181015003084 |
| Provider Name | Michael Newberry |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467569889 PECOS PAC ID: 6507929981 Enrollment ID: I20181231000042 |
| Provider Name | Chinwe Ibiam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598289860 PECOS PAC ID: 3870846553 Enrollment ID: I20191219001580 |
| Provider Name | Andrietta Barnett |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043648140 PECOS PAC ID: 4385875673 Enrollment ID: I20200314000134 |
| Provider Name | Andrietta Barnett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043648140 PECOS PAC ID: 4385875673 Enrollment ID: I20200325002265 |
| Provider Name | Leandra Lynette Davidson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588137764 PECOS PAC ID: 8325453848 Enrollment ID: I20210216001168 |
| Provider Name | Benjamin Robert Crawford |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215166871 PECOS PAC ID: 7113173980 Enrollment ID: I20210805003202 |
| Provider Name | Lance Timothy Washington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033783998 PECOS PAC ID: 1658777362 Enrollment ID: I20210903001904 |
| Provider Name | Barbara Jean Hathaway |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588770432 PECOS PAC ID: 0547173247 Enrollment ID: I20230418000638 |
| Provider Name | Adetutu Awodipe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386157857 PECOS PAC ID: 8628326089 Enrollment ID: I20230422000128 |
| Provider Name | Solomon Gezahgn Abebe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003526898 PECOS PAC ID: 5395100119 Enrollment ID: I20230501002545 |
| Provider Name | Tina Chinwenwa Ezeh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740996222 PECOS PAC ID: 1456711423 Enrollment ID: I20230721002907 |
| Provider Name | Noel Marie Trusal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326597246 PECOS PAC ID: 3971889668 Enrollment ID: I20230808001769 |
| Provider Name | Mary Michele Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124708599 PECOS PAC ID: 9830544899 Enrollment ID: I20231011000701 |
| Provider Name | Jennifer Rotella |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316727597 PECOS PAC ID: 9133575178 Enrollment ID: I20231026002102 |
| Provider Name | Charles Bishop Montjoy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528720497 PECOS PAC ID: 2860841814 Enrollment ID: I20231215001332 |
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