Nicole Fahs

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

61224496 Issued in WA

Practice address

300 Tuskegee Blvd # De19902
Dover AFB, DE 19902-5003

Phone

(302) 677-2574

NPI assigned

Oct 5, 2021

Last updated

Feb 9, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• The Center for Neurological and Neurodevelopmental Health, LLC

  dba CNNH

  • Neurology Physician
  • Voorhees, NJ
  • NPI 1962682989
  NPD (past)

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

{
    "created_epoch": "1633392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675900800000",
    "number": "1700558913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5955 ZEAMER AVE",
            "city": "ELMENDORF AFB",
            "state": "AK",
            "postal_code": "995063702",
            "telephone_number": "907-580-2778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 TUSKEGEE BLVD # DE19902",
            "city": "DOVER AFB",
            "state": "DE",
            "postal_code": "199025003",
            "telephone_number": "302-677-2574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAHS",
        "first_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-05",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "61224496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Lynn Dick, LCSW
• Peggy Lee Dickson, D.D.S.
• Kaylena Dornes
• Kathleen Drum, DNP, WHNP-BC
• Bernadette Ann Fackovec, MSW
• Jennifer Fleming
• Marcella Marie Fleming, RPH
• Vincent Paul Floryshak, DDS
• Christopher Francis Flynn, MD
• Dori Mitchell Franco, DO

• Psychiatric/Mental Health Nurse Practitioner in Dover AFB, DE
• Providers in Dover AFB, DE by specialty
• Psychiatric/Mental Health Nurse Practitioner in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; 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.