| Mrs Carleen Willeford, DNP | |
| 
					416 Main St, North Myrtle Beach, SC 29582-3024  | |
| (843) 663-0933 | |
| (843) 663-0936 | 
| Full Name | Mrs Carleen Willeford | 
|---|---|
| Gender | Female | 
| Speciality | Nurse Practitioner - Family | 
| Location | 416 Main St, North Myrtle Beach, South Carolina | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1164641908 | NPI | - | NPPES | 
| 016UX | Other | NC | BCBS NC PROVIDER NUMBER | 
| 8987642 | Medicaid | NC | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | APN3204RX (South Carolina) | Primary | 
| 363LF0000X | Nurse Practitioner - Family | 201524 (North Carolina) | Secondary | 
| Entity Name | Coastal Carolinas Integrated Medicine Ii | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1255158788 PECOS PAC ID: 6002357365 Enrollment ID: O20240926001640  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Mrs Carleen Willeford, DNP 10 Doctors Cir, Suite 2, Supply, NC 28462-4089 Ph: (910) 755-6060  | Mrs Carleen Willeford, DNP 416 Main St, North Myrtle Beach, SC 29582-3024 Ph: (843) 663-0933  | 
Roman Koryakin, FNP, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3816 Highway 17 S, North Myrtle Beach, SC 29582 Phone: 843-272-1411  | |
Alice Ruth Carter, APRN Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1714 Highway 17 S, North Myrtle Beach, SC 29582 Phone: 843-361-0705 Fax: 843-361-4045  | |
Sandra Lee Payne, APRN Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1010 Highway 17 N, North Myrtle Beach, SC 29582 Phone: 843-249-1451  | |
Ms. Stacey Lynn Shaw, APRN Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 2423 Highway 17 S, North Myrtle Beach, SC 29582 Phone: 843-919-0700 Fax: 843-919-0727  | |
Mrs. Tisha Michelle Brown, APRN, FNP-C Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1010 Highway 17 N, North Myrtle Beach, SC 29582 Phone: 866-389-2727  | |
Mrs. Barbie Suggs Anderson, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1714 Highway 17 S, North Myrtle Beach, SC 29582 Phone: 843-361-0705  | |
Tracey Michelle Lewis, APRN, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 2021 N Myrtle Point Blvd Ste 102, North Myrtle Beach, SC 29582 Phone: 843-366-3060 Fax: 843-366-3069  |