Individual provider Active NPI

Nicole Jean Wolfe, PA-C

  • Physician Assistant
  • State College, PA
National Provider Identifier
1841600855
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA056884 Issued in PA
Practice address
1850 E Park Ave
Ste 201
State College, PA 16803-6706
Phone
(814) 234-8800
Fax
(814) 235-1133
NPI assigned
Apr 29, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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 MA056884 PA Primary

Addresses

Primary practice location

1850 E Park Ave
Ste 201
State College, PA 16803-6706

Mailing address

1850 E Park Ave
Ste 201
State College, PA 16803-6706
Phone (814) 234-8800

Other names 1

  • Nicole Jean Young Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20140725001561 PA Practitioner - Physician Assistant 4587880687 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

120 Radnor Rd
Suite 100
State College, PA 16801-7970
Phone (814) 231-7868

129 Medical Park LN
Bellefonte, PA 16823-9112
Phone (814) 355-3626

141 Medical Park LN
Bellefonte, PA 16823-9112
Phone (814) 355-7322

143 Hospital Dr
State College, PA 16803-5500
Phone (814) 237-3470

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA056884PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Nittany Medical Center Health Services Inc CurrentSince Jul 7, 2014 Accepting new patients

Locations

141 Medical Park Ln
Bellefonte, PA 16823
Phone (814) 355-7322

1061 N Front St
Ste 2
Philipsburg, PA 16866
Phone (814) 231-7888

1850 E Park Ave
#201
State College, PA 16803
Phone (814) 234-8800

143 Hospital Dr
Ste 201
State College, PA 16803
Phone (814) 689-3140

120 Radnor Rd
Ste 100
State College, PA 16801
Phone (814) 231-7125

1850 E Park Ave
Ste 201
State College, PA 16803
Phone (814) 234-8800

Organizations & group practices 1

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1398729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1841600855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 E PARK AVE",
            "address_2": "STE 201",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036706",
            "telephone_number": "814-234-8800",
            "fax_number": "814-235-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 E PARK AVE",
            "address_2": "STE 201",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036706",
            "telephone_number": "814-234-8800",
            "fax_number": "814-235-1133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLFE",
        "first_name": "NICOLE",
        "middle_name": "JEAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-29",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA056884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "YOUNG",
            "middle_name": "JEAN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.