Active NPI
Nicole Ackley, PA
- Physician Assistant
- Bradford, PA
National Provider Identifier
1689763351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- MA052663
- Practice address
- 900 Chestnut Street Ext Ste a
Bradford, PA 16701-2298 - Phone
- (814) 368-8490
- NPI assigned
- Oct 12, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MA052663 | PA | Primary |
Addresses
Primary practice location
900 Chestnut Street Ext Ste a
Bradford, PA 16701-2298
Mailing address
900 Chestnut Street Ext Ste a
Bradford, PA 16701-2298
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA052663 | PA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bradford Regional Medical Services | Past | Accepting new patients |
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.
-
- Family Medicine Physician
- Bradford, PA
- NPI 1144273814
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474416000000",
"number": "1689763351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 CHESTNUT STREET EXT STE A",
"city": "BRADFORD",
"state": "PA",
"postal_code": "167012298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 CHESTNUT STREET EXT STE A",
"city": "BRADFORD",
"state": "PA",
"postal_code": "167012298",
"telephone_number": "814-368-8490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ACKLEY",
"first_name": "NICOLE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-12",
"last_updated": "2016-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "MA052663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bradford, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.