Nicole Carson

Key facts

NPI

1609653385

Entity type

Individual (NPI type 1)

Primary specialty

Home Health Aide 374U00000X

Practice address

4630 US Highway 68 N
Bellefontaine, OH 43311-9574

Phone

(937) 935-3797

NPI assigned

Sep 14, 2023

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 14, 2023.

{
    "created_epoch": "1694649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694649600000",
    "number": "1609653385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4630 US HIGHWAY 68 N",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "433119574",
            "telephone_number": "937-935-3797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4630 US HIGHWAY 68 N",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "433119574",
            "telephone_number": "937-935-3797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARSON",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-14",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Champaign Residential Services, Inc.

All providers in Bellefontaine, OH · Home Health Aide in Ohio