Healthcare Provider Details

I. General information

NPI: 1801293667
Provider Name (Legal Business Name): NICOLE LYNN SNINSKY PA-C, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. NICOLE LYNN STEPHENS

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 06/23/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 HUFFMAN MILL RD
BURLINGTON NC
27215-8700
US

IV. Provider business mailing address

1821 HILLANDALE RD SUITE 25 C
DURHAM NC
27705
US

V. Phone/Fax

Practice location:
  • Phone: 217-821-7843
  • Fax:
Mailing address:
  • Phone: 919-220-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096003446
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08977
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: