Healthcare Provider Details

I. General information

NPI: 1235877531
Provider Name (Legal Business Name): NICOLE MARIE KARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE MARIE O'MEARA NP

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15959 HALL RD STE LL104
MACOMB MI
48044-5364
US

IV. Provider business mailing address

15959 HALL RD STE LL104
MACOMB MI
48044-5364
US

V. Phone/Fax

Practice location:
  • Phone: 586-799-1212
  • Fax: 586-799-1210
Mailing address:
  • Phone: 586-799-1212
  • Fax: 586-799-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704327075
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: