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NICOLE EBALO
NPI 1073193546
Student in an Organized Health Care Education/Training Program in Fayetteville, NC

Active since April 09, 2021PECOS Enrolled
1638 OWEN DRIVE, FAYETTEVILLE, NC 28304(910) 615-4000 Get Directions Write a Review

NPPES record last updated: April 12, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Apr 12, 2021, Apr 9, 2021 (2 updates tracked since 2021).

About Nicole Ebalo NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICOLE EBALO (NPI 1073193546) is an individual student in an organized health care education/training program in Fayetteville, North Carolina and active in the NPI registry since April 2021. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1073193546
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameNICOLE EBALO
Location Address1638 OWEN DRIVEFayetteville, NC 28304
Mailing Address1638 Owen DriveFayetteville, NC 28304 · (910) 615-4000
Phone(910) 615-4000
Sole ProprietorYes
Enumeration DateApril 9, 2021
Last NPPES UpdateApril 12, 20212 updates tracked since enumeration
NPPES CertifiedApril 12, 2021
✔ NPI 1073193546 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1638 OWEN DRIVE, Fayetteville, NC 28304
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nicole Ebalo is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRENDA A ALCOCER APRN
Nurse Practitioner (Family)
1638 OWEN DRIVE
FAYETTEVILLE, NC 28304
Cumberland County (984) 977-8772
KALYAN RAM SAIGANESH
Student in an Organized Health Care Education/Training Program
1638 OWEN DRIVE
FAYETTEVILE, NC 28304
Cumberland County (910) 615-0000
ANTONIOS ANAGNOSTOPOULOS DO
Psychiatry & Neurology (Psychiatry)
1638 OWEN DRIVE
FAYETTEVILLE, NC 28304
Cumberland County (910) 615-5095
MATTHEW WESTON PRIOR DO
Student in an Organized Health Care Education/Training Program
1638 OWEN DRIVE
FAYETTEVILLE, NC 28304
Cumberland County (910) 615-4000
ERIC MICHAEL ACKER MD
Student in an Organized Health Care Education/Training Program
1638 OWEN DRIVE
FAYETTEVILLE, NC 28304
Cumberland County (910) 615-3960
BROOKE MARTIN DO
Student in an Organized Health Care Education/Training Program
1638 OWEN DRIVE
FAYETTEVILLE, NC 28304
Cumberland County (910) 615-4000
REBEKAH BRYTON CARY DO
Student in an Organized Health Care Education/Training Program
1638 OWEN DRIVE
FAYETTEVILLE, NC 28304
Cumberland County (910) 615-3500
DR. RYAN PURSLEY DO
Emergency Medicine
1638 OWEN DRIVE, BOX 138
FAYETTEVILLE, NC 28304
Cumberland County (910) 615-4530

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicole Ebalo's NPI number?

The NPI number for Nicole Ebalo is 1073193546. It was assigned to this individual provider in the NPPES registry on April 9, 2021.

Where is Nicole Ebalo located?

Nicole Ebalo practices at 1638 Owen Drive, Fayetteville, NC 28304. The listed phone number is (910) 615-4000.

What is Nicole Ebalo's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Nicole Ebalo enrolled in Medicare?

Yes. Nicole Ebalo is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Nicole Ebalo was last updated on April 12, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.