Healthcare Provider Details

I. General information

NPI: 1467113050
Provider Name (Legal Business Name): NICOLE CALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 PALMETTO COMMERCE PKWY
LADSON SC
29456-6701
US

IV. Provider business mailing address

5080 SPECTRUM DR STE 1200W
ADDISON TX
75001-4624
US

V. Phone/Fax

Practice location:
  • Phone: 854-888-3529
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4244
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: