Individual provider Active NPI

Nikita Glover, FNP

  • Family Nurse Practitioner
  • Waddington, NY
National Provider Identifier
1972985612
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
339790 Issued in NY
Practice address
4 Montgomery HTS
Waddington, NY 13694-7712
Phone
(153) 887-8723
Fax
(315) 713-6511
NPI assigned
Jun 18, 2015
Last updated
Sep 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 15, 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 339790 NY Primary
Hematology & Oncology Physician 207RH0003X 339790 NY

Addresses

Primary practice location

4 Montgomery HTS
Waddington, NY 13694-7712

Mailing address

4 Montgomery HTS
Waddington, NY 13694-7712
Phone (153) 887-8723

Other practice location 1

50 LeRoy St
Potsdam, NY 13676-1786
Phone (315) 265-3300

Other identifiers 1

IdentifierTypeStateIssuer
04179508MedicaidNY

Other names 1

  • Nikita Hungerford Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20160526001357 NY Practitioner - Nurse Practitioner 8325338775 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Canton-Potsdam HospitalGroup PAC ID 6204827280, 243 clinicians

Practice addresses (Care Compare)

50 Leroy St
Potsdam, NY 13676-1786
Phone (315) 265-3300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.56 of 100Reported as apm
Quality
87.76
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Canton-Potsdam Hospital CurrentSince Jan 5, 2023 Accepting new patients
Healey Medical Practice, PLLC CurrentSince Jul 15, 2020 Accepting new patients
Canton-Potsdam Hospital CurrentSince Jan 5, 2023 Accepting new patients

Locations

25 Park St
Canton, NY 13617
Phone (315) 379-9158

201 Market St
Ste E
Potsdam, NY 13676
Phone (315) 274-9102

50 Leroy St
Potsdam, NY 13676
Phone (315) 261-6034

Interoperability endpoints

  • Direct secure messaging: ngoliber@hiemail.healtheconnections.org
  • Direct secure messaging: ngoliber360136@direct.rochesterregional.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1434585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757894400000",
    "number": "1972985612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MONTGOMERY HTS",
            "city": "WADDINGTON",
            "state": "NY",
            "postal_code": "136947712",
            "telephone_number": "153-887-8723",
            "fax_number": "315-713-6511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MONTGOMERY HTS",
            "city": "WADDINGTON",
            "state": "NY",
            "postal_code": "136947712",
            "telephone_number": "153-887-8723",
            "fax_number": "315-713-6511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50 LeRoy St",
            "address_purpose": "LOCATION",
            "city": "Potsdam",
            "state": "NY",
            "postal_code": "136761786",
            "country_code": "US",
            "telephone_number": "315-265-3300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLOVER",
        "first_name": "NIKITA",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-18",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "339790",
            "primary": true
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NY",
            "license": "339790",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04179508",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NIKITA",
            "last_name": "HUNGERFORD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Waddington, NY

Sources for this page

Verify at the official NPI Registry.