Nicole Phuong Khanh Cao-Callicotte, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN279581 Issued in GA

Practice address

2324 Limestone Overlook
Gainesville, GA 30501-7443

Phone

(770) 536-8109

Fax

(678) 536-3203

NPI assigned

Jan 12, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Nicole Phuong Khanh Cao Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1641945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644883200000",
    "number": "1942951744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2324 LIMESTONE OVERLOOK",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305017443",
            "telephone_number": "770-536-8109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2324 LIMESTONE OVERLOOK",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305017443",
            "telephone_number": "770-536-8109",
            "fax_number": "678-536-3203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAO-CALLICOTTE",
        "first_name": "NICOLE",
        "middle_name": "PHUONG KHANH",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-12",
        "last_updated": "2022-02-15",
        "certification_date": "2022-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN279581",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN279581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "CAO",
            "middle_name": "PHUONG KHANH",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Quinton Victor Cancel, M.D.
• Allyssa Blaire Cantrell
• Roberto Cantu, PT
• Kerra Canup
• Kimberly Diane Canupp, AGACNP
• Zachary Cao, PT, DPT
• Cardiovascular Clinic of North Georgia PC
• Care Medical of Gainesville, LLC
• Careatc
• Caresouth HHA Holdings of Gainesville, LLC

• Family Nurse Practitioner in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.