Healthcare Provider Details

I. General information

NPI: 1023086089
Provider Name (Legal Business Name): NICOLE A CARSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4897 YORK ROAD
BUCKINGHAM PA
18912
US

IV. Provider business mailing address

PO BOX 278
BUCKINGHAM PA
18912-0278
US

V. Phone/Fax

Practice location:
  • Phone: 215-794-7471
  • Fax: 215-794-2576
Mailing address:
  • Phone: 215-794-7471
  • Fax: 215-794-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085002289
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA051781
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: