Healthcare Provider Details

I. General information

NPI: 1659925717
Provider Name (Legal Business Name): NICOLE RENEE CASTO PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 7 LAKES DR
WEST END NC
27376-9081
US

IV. Provider business mailing address

1127 7 LKS N
WEST END NC
27376-9756
US

V. Phone/Fax

Practice location:
  • Phone: 910-420-0226
  • Fax:
Mailing address:
  • Phone: 540-247-1516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024179001
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5017739
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: