Nickola Kim Wallace, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

TP006718B Issued in PA

Practice address

1001 S George St
BLDG MKB
York, PA 17405

Phone

(717) 851-2521

Fax

(717) 851-3535

NPI assigned

Jul 11, 2006

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 1

Other names 1

• Ms. Nickola Kim McCarty Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1326073040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1803 MOUNT ROSE AVE",
            "address_2": "SUITE B3",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174033026",
            "telephone_number": "717-851-1405",
            "fax_number": "717-851-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 S GEORGE ST",
            "address_2": "BLDG MKB",
            "city": "YORK",
            "state": "PA",
            "postal_code": "17405",
            "telephone_number": "717-851-2521",
            "fax_number": "717-851-3535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "NICKOLA",
        "middle_name": "KIM",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "TP006718B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "50048998",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICKOLA",
            "last_name": "MCCARTY",
            "middle_name": "KIM",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nermin Walker
• Quintisha Marie Walker, M.D.
• Septian Marie Walker, D.M.D
• Terrence Lee Walker, D.D.S
• Travis Carl Walker, M.D.
• Ruth Ellen Wallick, COTAL
• Shelby Wallick, LCSW
• Elise Ann Wallo, M.D.
• Meggen Walsh, DO
• Molly Walsh, MS, CCC-SLP

• Family Nurse Practitioner in York, PA
• Providers in York, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.