| Coastal Ridge Health Services, Pllc | |
|
14057 Us Highway 17 Ste 200 Hampstead NC 28443-3793 | |
| (910) 821-1418 | |
| (866) 860-0997 |
| Full Name | Coastal Ridge Health Services, Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 14057 Us Highway 17 Ste 200, Hampstead, North Carolina |
| Authorized Official Name and Position | Deborah S Jenks (OWNER/EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9108211418 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Ridge Health Services, Pllc 14057 Us Highway 17 Ste 200 Hampstead NC 28443-3793 Ph: (910) 821-1418 | Coastal Ridge Health Services, Pllc 14057 Us Highway 17 Ste 200 Hampstead NC 28443-3793 Ph: (910) 821-1418 |
| NPI Number | 1487133351 |
|---|---|
| Provider Enumeration Date | 08/10/2018 |
| Last Update Date | 01/11/2023 |
| Certification Date | 01/11/2023 |
| Medicare PECOS PAC ID | 4082968029 |
|---|---|
| Medicare Enrollment ID | O20181112000313 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487133351 | NPI | - | NPPES |
| 0024175505 | Other | VA | VIRGINIA NP NUMBER |
| 4461S | Other | NC | NORTH CAROLINA BOARD OF PROFESSIONAL COUNSELORS |
| 5009986 | Other | NC | NORTH CAROLINA LICENSE NUMBER |
| Provider Name | Deborah Sue Jenks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871550491 PECOS PAC ID: 5496042905 Enrollment ID: I20171205001330 |
| Provider Name | Carl Hurd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346914256 PECOS PAC ID: 3375954084 Enrollment ID: I20210909002088 |
| Provider Name | Christina M Hayden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053019653 PECOS PAC ID: 7719346253 Enrollment ID: I20230713003330 |
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