MEDICARE: DR. NICOLE YVONNE FRANKLIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD13453	RI
2	2084P0804X	Child & Adolescent Psychiatry Physician	30085	SC
3	2084P0804X	Child & Adolescent Psychiatry Physician	48463	TN
4	2084P0804X	Child & Adolescent Psychiatry Physician	C165291	CA

General Provider Information

NPI Number	:	1629275540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE YVONNE FRANKLIN M.D.

Provider Business Mailing Address
First Line	:	2891 RIVER VISTA WAY
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-2408
Country	:	US
Telephone Number	:	843-261-3053
Fax Number	:

Provider Business Practice Location Address
First Line	:	670 PLACERVILLE DR STE 2
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-4200
Country	:	US
Telephone Number	:	530-644-2412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	02/09/2021

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