Traci Lynn Nickelson, CNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN.CNP.020218 Issued in OH

Practice address

14121 Parke Long CT Ste 201
Chantilly, VA 20151-1647

Phone

(855) 247-1940

NPI assigned

Apr 26, 2017

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

Other names 1

• Traci Lynn Byerly Former name

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

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Complexcare Medical Group Midwest H PLLCGroup PAC ID 0143737148, 128 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Complexcare Medical Group Midwest H PLLC

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1457144933

  OH

  Medicare reassignment Care Compare group NPD
• Theoria Medical

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1609362375
  NPD

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

{
    "created_epoch": "1493164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493164800000",
    "number": "1831624956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 SPENCER ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436093030",
            "telephone_number": "419-203-3252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14121 PARKE LONG CT STE 201",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201511647",
            "telephone_number": "855-247-1940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKELSON",
        "first_name": "TRACI",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "CNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-04-26",
        "last_updated": "2017-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.020218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACI",
            "last_name": "BYERLY",
            "middle_name": "LYNN",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ngocanh Thi Nguyen
• Nhat Minh Nguyen, LCSW
• Quoc Nguyen, DDS
• Uyenchieu Nguyen
• Melissa J.P. Ni, LCSW
• Carl Nielsen
• Kamran Nikseresht, D.D.S
• Shirin Nikzad Farokhi, FNP
• Yu Nina Niu, M.D.
• Jinsuh Noh, BEHAVIOR TECHNICIAN

• Family Nurse Practitioner in Chantilly, VA
• Providers in Chantilly, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.