Active NPI
Nicole Marie Eaton, PA-C
- Physician Assistant
- Statesville, NC
National Provider Identifier
1760406490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 103697
- Practice address
- 208 Old Mocksville Rd
Statesville, NC 28625-1953 - Phone
- (704) 878-2021
- Fax
- (704) 878-2022
- NPI assigned
- Jul 26, 2006
- Last updated
- Apr 21, 2020
- 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 | 103697 | NC | Primary |
Addresses
Primary practice location
208 Old Mocksville Rd
Statesville, NC 28625-1953
Mailing address
650 Signal Hill Drive Ext
PO Box 1845
Statesville, NC 28625-4353
Phone (704) 873-4277
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587427200000",
"number": "1760406490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 SIGNAL HILL DRIVE EXT",
"address_2": "PO BOX 1845",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "286254353",
"telephone_number": "704-873-4277",
"fax_number": "704-873-4511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 OLD MOCKSVILLE RD",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "286251953",
"telephone_number": "704-878-2021",
"fax_number": "704-878-2022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EATON",
"first_name": "NICOLE",
"middle_name": "MARIE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-26",
"last_updated": "2020-04-21",
"certification_date": "2020-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "103697",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Statesville, NC
- Lee Hunter Easterwood, M.D.
- Eastside Pharmacy Services LLC (Banner Drug)
- Eastside Pharmacy Services LLC (Banner Drug Co)
- Eastside Pharmacy Services, LLC (Banner Drug LTC)
- Eastside Pharmacy Services, LLC (Banner Drug Downtown Satatesville)
- Eckerd Corporation (Rite Aid Pharmacy 11547)
- Ida Lee Eden, MS, CCC-SLP
- Kristen Eden, PT, DPT
- Dominiquea Edmiston, LCSW
- Amy Perras Eisele, LCSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.