Individual provider Active NPI

Nichole Reid, CRNP

  • Acute Care Nurse Practitioner
  • Mount Holly, NJ
National Provider Identifier
1861660110
Registry record updated Dec 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
26NJ00331600 Issued in NJ
Practice address
175 Madison Ave FL 1
Mount Holly, NJ 08060-2099
Phone
(609) 914-6000
NPI assigned
Feb 20, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP009748 PA
Acute Care Nurse Practitioner 363LA2100X 26NJ00331600 NJ Primary

Addresses

Primary practice location

175 Madison Ave FL 1
Mount Holly, NJ 08060-2099

Mailing address

3400 Spruce St
Ground Floor Dulles
Philadelphia, PA 19104-4206
Phone (215) 662-3005

Other practice location 1

3400 Spruce St
Ground Floor Dulles
Philadelphia, PA 19104-4206
Phone (215) 662-3005

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address nreid284091@directvirtua.org
Direct Messaging Address nreid284091@directvirtua.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20180928000757 NJ Practitioner - Nurse Practitioner 0941387518 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ00331600NJMDAcute Care Nurse Practitioner
SP009748PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Virtua Medical Group, PA CurrentSince Oct 1, 2024 Accepting new patients
Virtua Medical Group, PA CurrentSince Oct 1, 2024 Accepting new patients
Virtua Medical Group, PA Current Accepting new patients
Kennedy Medical Group Practice, P.C. PastSince Jun 15, 2021 Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

175 Madison Ave
Fl 1
Mount Holly, NJ 08060
Phone (609) 914-6000

218 Sunset Rd
Fl 2
Willingboro, NJ 08046
Phone (609) 444-0599

Organizations & group practices 4

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": "1203465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766448000000",
    "number": "1861660110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "address_2": "GROUND FLOOR DULLES",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-662-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 MADISON AVE FL 1",
            "city": "MOUNT HOLLY",
            "state": "NJ",
            "postal_code": "080602099",
            "telephone_number": "609-914-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3400 Spruce St",
            "address_2": "Ground Floor Dulles",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191044206",
            "country_code": "US",
            "telephone_number": "215-662-3005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REID",
        "first_name": "NICHOLE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-20",
        "last_updated": "2025-12-23",
        "certification_date": "2025-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP009748",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NJ",
            "license": "26NJ00331600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nreid284091@directvirtua.org",
            "affiliation": "N",
            "address_1": "175 Madison Ave Fl 1",
            "city": "Mount Holly",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080602099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nreid284091@directvirtua.org",
            "affiliation": "N",
            "address_1": "218 Sunset Rd Fl 2",
            "city": "Willingboro",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080461110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Holly, NJ

Sources for this page

Verify at the official NPI Registry.