Nicole Kanomata, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F10220404 Issued in MI

Practice address

1465 E Parkdale Ave
Manistee, MI 49660-9709

Phone

(231) 876-6421

Fax

(231) 876-6430

NPI assigned

Sep 26, 2022

Last updated

Jan 15, 2025By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in MI, CA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Munson Healthcare CadillacGroup PAC ID 6305161514, 104 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Munson Healthcare Manistee Hospital Hospital, Manistee, MI, CCN 230303
• Munson Healthcare Cadillac Hospital Hospital, Cadillac, MI, CCN 230081
• Sutter Coast Hospital Hospital, Crescent City, CA, CCN 050417

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nicole.kanomata@mhc.direct.varian.com

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.

• Munson Healthcare Cadillac

  dba McBain Primary Care

  • Rural Health Clinic/Center
  • McBain, MI
  • NPI 1336539063
  Medicare reassignment Care Compare group NPD
• Stallant Medical Group Inc

  • Rural Health Clinic/Center
  • Crescent City, CA
  • NPI 1366082463
  Medicare reassignment
• Munson Healthcare Cadillac

  dba Munson Healthcare Cadillac Physician Network

  • Family Medicine Physician
  • Cadillac, MI
  • NPI 1487051611
  NPD
• Munson Healthcare Cadillac

  • Psychiatry Physician
  • Traverse City, MI
  • NPI 1720955081
  NPD
• Munson Healthcare Cadillac

  dba Cadillac Primary Care & OBGYN

  • Obstetrics & Gynecology Physician
  • Cadillac, MI
  • NPI 1366828527

  Family

  NPD (past)

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

• Munson Healthcare Cadillac

  dba Munson Healthcare Cadillac Physician Network

  • Family Medicine Physician
  • Cadillac, MI
  • NPI 1487051611

  Hospital

  Care Compare affiliation
• Munson Healthcare Cadillac

  • General Acute Care Hospital
  • Cadillac, MI
  • NPI 1841696754
  Care Compare affiliation
• Munson Healthcare Manistee Hospital

  • General Acute Care Hospital
  • Manistee, MI
  • NPI 1407949191
  Care Compare affiliation
• Sutter Coast Hospital

  • General Acute Care Hospital
  • Crescent City, CA
  • NPI 1457367062
  Care Compare affiliation
• Sutter Coast Hospital

  dba Sutter Coast Community Clinic

  • General Practice Physician
  • Crescent City, CA
  • NPI 1700960267

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1664150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1366165102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 SIXTH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 E PARKDALE AVE",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496609709",
            "telephone_number": "231-876-6421",
            "fax_number": "231-876-6430"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Hobart St",
            "address_purpose": "LOCATION",
            "city": "Cadillac",
            "state": "MI",
            "postal_code": "496012331",
            "country_code": "US",
            "telephone_number": "231-876-6421",
            "fax_number": "231-876-6430",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "217 S Madison St",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496842321",
            "country_code": "US",
            "telephone_number": "231-392-8400",
            "fax_number": "231-392-8467",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KANOMATA",
        "first_name": "NICOLE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-26",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "F10220404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jill Rene Johnson, LMSW
• Jordan Johnson
• Krystal Kay Johnston, M.D.
• Holly Joseph
• Justin P Terry DDS PLLC
• Charles Joseph Keil, O.D.
• Michael Keith
• Faith Yung Min Kelley, FNP-BC
• Kenneth a Borenitsch D O P C
• Jesse Leah Keson, FNP

• Family Nurse Practitioner in Manistee, MI
• Providers in Manistee, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.