Healthcare Provider Details

I. General information

NPI: 1669985362
Provider Name (Legal Business Name): NICHOLE RENEE CARLTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 DOCTORS CIR BLDG C
WILMINGTON NC
28401-7403
US

IV. Provider business mailing address

166 E VIRGINIA AVE
SEBRING OH
44672-1443
US

V. Phone/Fax

Practice location:
  • Phone: 910-662-7500
  • Fax: 910-662-7501
Mailing address:
  • Phone: 330-257-2916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-14992
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.005282RX
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number50.005282RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: