NPIMap

Individual provider Active NPI

Nicole Jean Carroll, PA

  • Physician Assistant
  • Oklahoma City, OK
National Provider Identifier
1336321827
Registry record updated Apr 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1665 Issued in OK
Practice address
8100 S Walker Ave BLDG a
Oklahoma City, OK 73139-9475
Phone
(405) 632-4468
Fax
(405) 632-0436
NPI assigned
Nov 27, 2007
Last updated
Apr 23, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1665 OK Primary
Medical Physician Assistant 363AM0700X 1665 OK
Surgical Physician Assistant 363AS0400X 1665 OK

Addresses

Primary practice location

8100 S Walker Ave BLDG a
Oklahoma City, OK 73139-9475

Mailing address

8100 S Walker Ave BLDG a
Oklahoma City, OK 73139-9475
Phone (405) 632-4468

Other identifiers 1

IdentifierTypeStateIssuer
1665OtherOKMEDICAL LICENSE

Other names 1

  • Nicole Jean Shephard Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20090923000487 OK Practitioner - Physician Assistant 2860548443 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2506 N Harrison St
Shawnee, OK 74804-3131
Phone (405) 395-9050

8100 S Walker Ave
BLDG a
Oklahoma City, OK 73139-9475

8100 S Walker Ave BLDG a
Southwest Orthopaedic and Reconstructive
Oklahoma City, OK 73139-9475
Phone (405) 632-4468

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1665OKMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Logan County, Inc CurrentSince Sep 24, 2017 Accepting new patients
Southwest Orthopaedic Specialists, PLLC CurrentSince Mar 17, 2013 Accepting new patients
Southwest Orthopaedic Specialists, PLLC CurrentSince Mar 17, 2013 Accepting new patients
Oklahoma Center for Orthopaedic & Multi-Specialty Surgery, LLC Past Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Mercy Health Services Inc. Past Accepting new patients
Summit Medical Center Past Accepting new patients
Southwest Orthopaedic Specialists, P.L.L.C. Past Accepting new patients

Locations

200 S Academy Rd
Guthrie, OK 73044
Phone (405) 260-4165

6001 NW 139th St
Ste A
Oklahoma City, OK 73142
Phone (405) 635-3511

8100 S Walker Ave
Bldg A
Oklahoma City, OK 73139

2506 N Harrison St
Shawnee, OK 74804
Phone (405) 214-0300

1805 Commons Cir
Ste 100C
Yukon, OK 73099
Phone (405) 265-0165

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/ed29dd2e-7f6b-4b48-93ba-6ba78c79cd2d/
  • Direct secure messaging: ncarroll@direct.uspi.com
  • Direct secure messaging: ncarroll72460@direct.integrisok.com

Organizations & group practices 9

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 4

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

NPI Registry JSON

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

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555977600000",
    "number": "1336321827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8100 S WALKER AVE BLDG A",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731399475",
            "telephone_number": "405-632-4468",
            "fax_number": "405-632-0436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8100 S WALKER AVE BLDG A",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731399475",
            "telephone_number": "405-632-4468",
            "fax_number": "405-632-0436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "NICOLE",
        "middle_name": "JEAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-27",
        "last_updated": "2019-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1665",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "1665",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OK",
            "license": "1665",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "1665",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "SHEPHARD",
            "middle_name": "JEAN",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.