Katie Gardner Nickerson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

2251 Issued in SC

Practice address

8740 Rivers Ave
North Charleston, SC 29406-9211

Phone

(843) 572-5990

NPI assigned

Jan 4, 2012

Last updated

Mar 9, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Medcare Express - North Charleston LLC

  dba Medcare Urgent Care

  • Urgent Care Clinic/Center
  • Charleston, SC
  • NPI 1457579617
  Medicare reassignment NPD
• Long Term Care Nurse Practitioner Services, LLC

  • Nurse Practitioner
  • Atlanta, GA
  • NPI 1235401423
  NPD (past)
• Rex Hospital Inc

  dba North Carolina Heart and Vascular

  • Cardiovascular Disease Physician
  • Raleigh, NC
  • NPI 1972939643
  NPD (past)

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

{
    "created_epoch": "1325635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489017600000",
    "number": "1720358070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8740 RIVERS AVE",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069211",
            "telephone_number": "843-572-5990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8740 RIVERS AVE",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069211",
            "telephone_number": "843-572-5990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "KATIE",
        "middle_name": "GARDNER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-04",
        "last_updated": "2017-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-03197",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "2251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lois Ngo Fagiani
• Anh Quoc Pham Nguyen
• NHC Homecare-South Carolina LLC (NHC HomeCare-Low Country)
• Wendy Nichols
• Rebecca Nickell, PHARMD, RPH
• Patricia M Nicklas, DDS
• Samuel Walker Nickles, M.D.
• Carrie S Niemann, D.D.S
• Jeffrey Gerard Nigro, LISW-CP
• Elizabeth Ninneman, DPT

• Medical Physician Assistant in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Medical Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2017; 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.

Verify at the official NPI Registry.