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CANNERCHARLES PLLC
NPI 1215755764
Clinic/Center - Primary Care in Corolla, NC

Active since October 02, 2024CLIA 34D2300178 · Waiver
1129 COROLLA VILLAGE RD C, COROLLA, NC 27927(252) 597-1157(833) 972-1688 Get Directions Write a Review

NPPES record last updated: October 2, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Cannercharles Pllc NPPES

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

CANNERCHARLES PLLC (NPI 1215755764), doing business as Lighthouse Medical Care, is a healthcare organization registered as a primary care in Corolla, North Carolina and active in the NPI registry since October 2024. The organization holds a CLIA Waiver certificate valid through March 4, 2028 and lists Emily Krauter, Billing Manager, as its authorized official.

NPPES Registry Identity

NPI1215755764
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameCANNERCHARLES PLLC
Location Address1129 COROLLA VILLAGE RD CCorolla, NC 27927
Mailing Address1201 Lake James Dr Ste 200Virginia Beach, VA 23464-6780 · (757) 523-0022
Phone(252) 597-1157
Fax(833) 972-1688
Organization SubpartNo
Authorized OfficialEmily KrauterBilling Manager · (757) 523-0022
Enumeration DateOctober 2, 2024
NPPES CertifiedOctober 2, 2024
✔ NPI 1215755764 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
1129 COROLLA VILLAGE RD C, Corolla, NC 27927
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Other Names 1

Doing Business AsLighthouse Medical Care

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D2300178

Cannercharles PLLC · Corolla, NC
Active · expires Mar 4, 2028
CLIA Number34D2300178
Laboratory TypePhysician Office
Certificate Effective DateMarch 5, 2026
Certificate Expiration DateMarch 4, 2028
Laboratory DirectorRobert C. Blackwood
Laboratory Phone(757) 285-4915
Laboratory LocationCannercharles PLLC1129 C Corolla Village Rd, Corolla, NC 27927
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

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 Cannercharles PLLC's NPI number?

The NPI number for Cannercharles PLLC is 1215755764. It was assigned to this organization in the NPPES registry on October 2, 2024. The provider is doing business as Lighthouse Medical Care.

Where is Cannercharles PLLC located?

Cannercharles PLLC is located at 1129 Corolla Village Rd C, Corolla, NC 27927. The listed phone number is (252) 597-1157.

What is Cannercharles PLLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Cannercharles PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2300178) is associated with this NPI, valid through March 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Cannercharles PLLC was last updated on October 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.