Individual provider Active NPI

Nicole Marie Campbell Skaggs, PA

  • Physician Assistant
  • Charleston, SC
National Provider Identifier
1881070928
Registry record updated Jun 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
9330 Medical Plaza Dr
Charleston, SC 29406-9104
Phone
(843) 797-7000
NPI assigned
Jul 30, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 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 NY Primary

Addresses

Primary practice location

9330 Medical Plaza Dr
Charleston, SC 29406-9104

Mailing address

3959 Broadway
New York, NY 10032-1559

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

State licenses

LicenseStateTypeSpecialty
018960NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York CurrentSince Nov 15, 2015 Accepting new patients

Locations

3959 Broadway
New York, NY 10032
Phone (212) 304-7297

2026 Richmond Rd
Staten Island, NY 10306
Phone (212) 305-2300

Interoperability endpoints

  • Direct secure messaging: nicole.campbell@ghuc.eclinicaldirectplus.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1438214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561507200000",
    "number": "1881070928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3959 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9330 MEDICAL PLAZA DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294069104",
            "telephone_number": "843-797-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKAGGS",
        "first_name": "NICOLE",
        "middle_name": "MARIE CAMPBELL",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-30",
        "last_updated": "2019-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.