Active NPI
Nicole Killian
- Pediatric Nurse Practitioner
- Dacula, GA
National Provider Identifier
1679985691
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- RN207183
- Practice address
- 3619 Braselton Hwy Ste 103
Dacula, GA 30019-4668 - Phone
- (770) 513-8882
- NPI assigned
- May 25, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | RN207183 | GA | Primary |
Addresses
Primary practice location
3619 Braselton Hwy Ste 103
Dacula, GA 30019-4668
Mailing address
801 Mill Brook LN
Hoschton, GA 30548-3726
Phone (770) 883-2653
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190109002916 | GA | Order and Referring Only - Nurse Practitioner | 6002152253 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| R. David Thomson, MD, LLC | Past | Accepting new patients | |
| Samantha Ball DO LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Dacula, GA
- NPI 1417194218
-
- Pediatrics Physician
- Dacula, GA
- NPI 1942938311
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416960000000",
"number": "1679985691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 MILL BROOK LN",
"city": "HOSCHTON",
"state": "GA",
"postal_code": "305483726",
"telephone_number": "770-883-2653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3619 BRASELTON HWY STE 103",
"city": "DACULA",
"state": "GA",
"postal_code": "300194668",
"telephone_number": "770-513-8882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KILLIAN",
"first_name": "NICOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-05-25",
"last_updated": "2014-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "GA",
"license": "RN207183",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dacula, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2014; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.