Individual provider Active NPI

Carrie Licht, CNP

  • Family Nurse Practitioner
  • Wooster, OH
National Provider Identifier
1558243170
Registry record updated Jul 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0039851 Issued in OH
Practice address
1761 Beall Ave
Wooster, OH 44691-2342
Phone
(330) 263-8100
NPI assigned
Jul 24, 2025
Last updated
Jul 24, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0039851 OH Primary

Addresses

Primary practice location

1761 Beall Ave
Wooster, OH 44691-2342

Mailing address

160 Myers St
Creston, OH 44217-9704
Phone (912) 467-3215

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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 1

Enrollment IDStateProvider typePAC IDDetails
I20250909000358 OH Practitioner - Nurse Practitioner 5193227023 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1761 Beall Ave
Wooster, OH 44691-2342

1761 Beall Ave
Wooster, OH 44691-2399

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0039851OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bloomington Medical Services LLC CurrentSince Sep 1, 2025 Accepting new patients

Locations

1761 Beall Ave
Wooster, OH 44691
Phone (330) 263-8100

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1753315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753315200000",
    "number": "1558243170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 MYERS ST",
            "city": "CRESTON",
            "state": "OH",
            "postal_code": "442179704",
            "telephone_number": "912-467-3215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1761 BEALL AVE",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446912342",
            "telephone_number": "330-263-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICHT",
        "first_name": "CARRIE",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-07-24",
        "last_updated": "2025-07-24",
        "certification_date": "2025-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "0039851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wooster, OH

Sources for this page

Verify at the official NPI Registry.