Nicole E. Myers, PA-C
Individual provider Active NPI Medical Physician Assistant · Nyssa, OR
NPI 1174620249 · NPPES record last updated Mar 31, 2008
Key facts
- NPI
- 1174620249
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA01135 (OR)
- Practice address
- 17 S 3Rd St
Nyssa, OR 97913-3815 - Phone
- (541) 372-5738
- Fax
- (541) 372-5732
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OR, ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071114000123 | OR | Practitioner - Physician Assistant | 7214025931 | Reassigns benefits to 1 organization |
| I20241209004176 | ID | Practitioner - Physician Assistant | 7214025931 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA01135 | OR | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valley Family Health Care, Inc | Current |
Accepting new patients | |
| Valley Family Health Care Inc | Current |
Accepting new patients | |
| Valley Family Health Care, Inc | Current |
Accepting new patients |
Locations
207 E 12th St
Emmett, ID 83617
Phone (208) 365-1065
1441 NE 10th Ave
Payette, ID 83661
Phone (208) 642-9376
17 S 3rd St
Nyssa, OR 97913
Phone (541) 372-5738
896 Fortner St
Ontario, OR 97914
Phone (541) 709-2038
789 Washington St W
Vale, OR 97918
Phone (503) 473-2101
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA01135 | OR | Yes |
Addresses
Primary practice location
17 S 3Rd St
Nyssa, OR 97913-3815
Mailing address
17 S 3Rd St
Nyssa, OR 97913-3815
Phone (541) 372-5738
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA01135 | Other | OR | OREGON PA LICENSE |
Other providers in Nyssa, OR
- Darci Jennings
- Angela Locke
- Malheur Memorial Health Center
- Spencer Joseph Marsden
- Ruston R Munk
- Nyssa School District #26
- Thomas Pitts
- Valley Family Health Care, Inc
- Valley Family Health Care, Inc
- Rajaa Zayoud
All providers in Nyssa, OR · Medical Physician Assistant in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.