NPIMap

Individual provider Active NPI

Miranda Nicely, FNP-C

  • Family Nurse Practitioner
  • Bath, ME
National Provider Identifier
1083438774
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CNP241405 Issued in ME
Practice address
108 Centre St Ste 200
Bath, ME 04530-2550
Phone
(207) 386-1800
NPI assigned
Nov 11, 2024
Last updated
Nov 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X CNP241405 ME Primary

Addresses

Primary practice location

108 Centre St Ste 200
Bath, ME 04530-2550

Mailing address

PO Box 620
West Farmington, ME 04992-0620

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241205002209 ME Practitioner - Nurse Practitioner 3971039546 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

108 Centre St
Bath, ME 04530-2550

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CNP241405MEMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Jan 27, 2025 Accepting new patients
Mainehealth CurrentSince Jan 27, 2025 Accepting new patients
Mainehealth Current Accepting new patients

Locations

108 Centre St
#200
Bath, ME 04530
Phone (207) 386-1800

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

Interoperability endpoints

  • Direct secure messaging: mnicely892449@direct.mmc.mainehealth.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 37

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 37

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1083438774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 620",
            "city": "WEST FARMINGTON",
            "state": "ME",
            "postal_code": "049920620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 CENTRE ST STE 200",
            "city": "BATH",
            "state": "ME",
            "postal_code": "045302550",
            "telephone_number": "207-386-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICELY",
        "first_name": "MIRANDA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-11",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ME",
            "license": "CNP241405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bath, ME

Sources for this page

Verify at the official NPI Registry.