Active NPI
Linda A Nicolette, MD
- Pediatric Surgery Physician
- Albuquerque, NM
National Provider Identifier
1265476550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Surgery Physician
- License
- 91-101
- Practice address
- 201 Cedar St SE Ste 4660
Albuquerque, NM 87106-4924 - Phone
- (505) 563-6530
- Fax
- (505) 563-6336
- NPI assigned
- Jun 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 204554 | NY | |
| Pediatric Surgery Physician | 2086S0120X | 204554 | NY | |
| Pediatric Surgery Physician | 2086S0120X | 91-101 | NM | Primary |
Addresses
Primary practice location
201 Cedar St SE Ste 4660
Albuquerque, NM 87106-4924
Mailing address
PO Box 26666
PHS Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 923-6770
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01690293 | Medicaid | NY | |
| 56509766 | Medicaid | NM |
Other names 1
- Linda Deckler
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 204554 | NY | MD | Pediatric Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458864000000",
"number": "1265476550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 26666",
"address_2": "PHS PROVIDER ENROLLMENT",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871256666",
"telephone_number": "505-923-6770",
"fax_number": "505-923-5354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 CEDAR ST SE STE 4660",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871064924",
"telephone_number": "505-563-6530",
"fax_number": "505-563-6336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOLETTE",
"first_name": "LINDA",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-16",
"last_updated": "2016-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NY",
"license": "204554",
"primary": false
},
{
"code": "2086S0120X",
"taxonomy_group": "",
"desc": "Surgery, Pediatric Surgery",
"state": "NY",
"license": "204554",
"primary": false
},
{
"code": "2086S0120X",
"taxonomy_group": "",
"desc": "Surgery, Pediatric Surgery",
"state": "NM",
"license": "91-101",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01690293",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "56509766",
"state": "NM"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LINDA",
"last_name": "DECKLER",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.