Healthcare Provider Details

I. General information

NPI: 1194801001
Provider Name (Legal Business Name): NIKOL DEEM TIMMONS PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6051 TYVOLA GLEN CIR
CHARLOTTE NC
28217-6431
US

IV. Provider business mailing address

PO BOX 360
SYLVA NC
28779-0360
US

V. Phone/Fax

Practice location:
  • Phone: 704-774-6569
  • Fax: 855-308-2340
Mailing address:
  • Phone: 888-339-6065
  • Fax: 828-538-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number101627
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: