Nicole Rae Mendoza, RN, MSN, FNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

201508266NP-PP Issued in OR

Practice address

19 Myrtle St
Medford, OR 97504-7337

Phone

(542) 773-3863

NPI assigned

Feb 1, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

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

{
    "created_epoch": "1454284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613088000000",
    "number": "1649638974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "329 S IVY ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975013174",
            "telephone_number": "541-897-7383",
            "fax_number": "541-320-9023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 MYRTLE ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047337",
            "telephone_number": "542-773-3863"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1840 E Barnett Rd",
            "address_2": "Suite B",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "OR",
            "postal_code": "97504",
            "country_code": "US",
            "telephone_number": "541-897-7383",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "329 S Ivy St",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "OR",
            "postal_code": "975013174",
            "country_code": "US",
            "telephone_number": "541-897-7383",
            "fax_number": "541-320-9023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "NICOLE",
        "middle_name": "RAE",
        "credential": "RN, MSN, FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-01",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201508266NP-PP",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "201508266NP-PP",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OR",
            "license": "201508266NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Autumn Dawn Mercer, FNP
• Mercy Flights Incorporated
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• Primary Care Nurse Practitioner in Medford, OR
• Providers in Medford, OR by specialty
• Primary Care Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.