Healthcare Provider Details

I. General information

NPI: 1215052113
Provider Name (Legal Business Name): NICOLE HELEN BYARS P.A-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE HELEN DI MERCURIO

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 LONE TREE WAY
ANTIOCH CA
94509-6200
US

IV. Provider business mailing address

2100 POWELL ST STE 900
EMERYVILLE CA
94608-1826
US

V. Phone/Fax

Practice location:
  • Phone: 925-779-7200
  • Fax:
Mailing address:
  • Phone: 510-350-2664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 17580
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-11193
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: