Healthcare Provider Details

I. General information

NPI: 1770004822
Provider Name (Legal Business Name): NICOLE FAUCETTE HABIT DNP, PMHNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 TIFFANY BLVD
ROCKY MOUNT NC
27804-1812
US

IV. Provider business mailing address

350 PEE DEE AVE STE 101
ALBEMARLE NC
28001-4945
US

V. Phone/Fax

Practice location:
  • Phone: 252-442-0333
  • Fax:
Mailing address:
  • Phone: 704-986-1500
  • Fax: 704-986-5279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number240436
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5009590
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: