Individual provider Active NPI

Natalie Elizabeth Nickles, PA-C

  • Physician Assistant
  • Boardman, OH
National Provider Identifier
1730668138
Registry record updated Jan 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.005586RX Issued in OH
Practice address
8401 Market St
Boardman, OH 44512-6725
Phone
(330) 729-4298
Fax
(330) 729-1897
NPI assigned
Aug 7, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.005586RX OH Primary

Addresses

Primary practice location

8401 Market St
Boardman, OH 44512-6725

Mailing address

8401 Market St
Boardman, OH 44512-6725
Phone (330) 729-4298

Other practice location 1

667 Eastland Ave SE
Warren, OH 44484-4503
Phone (330) 841-2378

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20190213002294 OH Practitioner - Physician Assistant 5597003772 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50.005586RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Partners Physician Group CurrentSince Jan 1, 2023 Accepting new patients
Partners Physician Group CurrentSince Jan 1, 2023 Accepting new patients
The Cleveland Clinic Foundation CurrentSince Oct 31, 2025 Accepting new patients
The Cleveland Clinic Foundation CurrentSince Oct 31, 2025 Accepting new patients

Locations

224 W Exchange St
Ste 160
Akron, OH 44302
Phone (330) 344-6505

1320 Timken Mercy Dr NW
Canton, OH 44708
Phone (330) 489-1000

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

6801 Brecksville Rd
Ste 20
Seven Hills, OH 44131
Phone (216) 445-3363

8401 Market St
Youngstown, OH 44512
Phone (330) 729-2929

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1533600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547596800000",
    "number": "1730668138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 MARKET ST",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445126725",
            "telephone_number": "330-729-4298",
            "fax_number": "330-279-1897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 MARKET ST",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445126725",
            "telephone_number": "330-729-4298",
            "fax_number": "330-729-1897"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "667 Eastland Ave SE",
            "address_purpose": "LOCATION",
            "city": "Warren",
            "state": "OH",
            "postal_code": "444844503",
            "country_code": "US",
            "telephone_number": "330-841-2378",
            "fax_number": "330-841-4667",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICKLES",
        "first_name": "NATALIE",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-07",
        "last_updated": "2019-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.005586RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

Verify at the official NPI Registry.