Active NPI
Carroll John Nickle, D.O.
- Aerospace Medicine Physician
- Virginia Beach, VA
National Provider Identifier
1497757108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Aerospace Medicine Physician
- License
- 19464
- Practice address
- 1224 Chattingham Dr
Virginia Beach, VA 23464-5836 - Phone
- (757) 495-2719
- NPI assigned
- Aug 12, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Aerospace Medicine Physician | 2083A0100X | 19464 | CO | Primary |
Addresses
Primary practice location
1224 Chattingham Dr
Virginia Beach, VA 23464-5836
Mailing address
1224 Chattingham Dr
Virginia Beach, VA 23464-5836
Phone (757) 495-2719
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)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19464 | CO | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1497757108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1224 CHATTINGHAM DR",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234645836",
"telephone_number": "757-495-2719"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1224 CHATTINGHAM DR",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234645836",
"telephone_number": "757-495-2719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKLE",
"first_name": "CARROLL",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-12",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "2083A0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Aerospace Medicine",
"state": "CO",
"license": "19464",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.