Nicollette Leigh Pauksta, BSN, RN, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

078458 Issued in SC

Practice address

101 E Wood St
Spartanburg, SC 29303-3040

Phone

(864) 560-6122

Fax

(864) 560-6276

NPI assigned

Jan 8, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

State licenses

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

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287014400000",
    "number": "1285819326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277723",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303847723",
            "telephone_number": "864-560-4123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E WOOD ST",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293033040",
            "telephone_number": "864-560-6122",
            "fax_number": "864-560-6276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAUKSTA",
        "first_name": "NICOLLETTE",
        "middle_name": "LEIGH",
        "credential": "BSN, RN, CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-08",
        "last_updated": "2010-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SC",
            "license": "078458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00846188",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AN1652",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Steifle Patrick, M.D.
• Thomas Johnston Patrick Jr., DPM
• Lauren Dawn Patterson, NP
• Ohnyale Patterson, BS
• Jennifer Mitchell Patton, CRNA
• Paul Keane
• Deann Lynn Payne, PSYD
• Eloise W Pea
• Peach Valley Pharmacy LLC
• Peach Valley Pharmacy, Inc.

• Certified Registered Nurse Anesthetist in Spartanburg, SC
• Providers in Spartanburg, SC by specialty
• Certified Registered Nurse Anesthetist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.