Stephanie Nickerson, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024177488 Issued in VA

Practice address

3 Riverside Cir
Roanoke, VA 24016-4955

Phone

(540) 224-5170

NPI assigned

Jun 12, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 4

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA

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

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Carilion Healthcare CorporationGroup PAC ID 5890607253, 540 clinicians

Carilion Medical CenterGroup PAC ID 9830096585, 956 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carilion Medical Center Hospital, Roanoke, VA, CCN 490024
• Carilion Franklin Memorial Hospital Hospital, Rocky Mount, VA, CCN 490089
• Carilion New River Valley Medical Center Hospital, Christiansburg, VA, CCN 490042

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: snickerson122803@direct.carilionclinic.org

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.

• Carilion Healthcare Corporation

  • Multi-Specialty Clinic/Center
  • Roanoke, VA
  • NPI 1447206370
  Medicare reassignment Care Compare group NPD
• Carilion Medical Center

  • Multi-Specialty Clinic/Center
  • Roanoke, VA
  • NPI 1730123472
  Medicare reassignment Care Compare group NPD
• Carilion Rockbridge Community Hospital

  • Critical Access Hospital
  • Lexington, VA
  • NPI 1518950484
  Medicare reassignment
• Carilion Healthcare Corporation

  • Durable Medical Equipment & Medical Supplies
  • Blacksburg, VA
  • NPI 1407667256
  NPD
• Carilion Medical Center

  • Durable Medical Equipment & Medical Supplies
  • Hardy, VA
  • NPI 1073324810
  NPD

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

• Carilion Franklin Memorial Hospital

  • General Acute Care Hospital
  • Rocky Mount, VA
  • NPI 1710970918
  Care Compare affiliation
• Carilion Medical Center

  • General Acute Care Hospital
  • Roanoke, VA
  • NPI 1033102942
  Care Compare affiliation
• Carilion New River Valley Medical Center

  • General Acute Care Hospital
  • Christiansburg, VA
  • NPI 1376536573
  Care Compare affiliation

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

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746748800000",
    "number": "1982966206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 S JEFFERSON ST STE 1006",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240111713",
            "telephone_number": "540-224-5715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 RIVERSIDE CIR",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164955",
            "telephone_number": "540-224-5170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "STEPHANIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-12",
        "last_updated": "2025-05-09",
        "certification_date": "2025-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024177488",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP131784",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "207247-6",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024177488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8328MA",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "368109001",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "snickerson122803@direct.carilionclinic.org",
            "affiliation": "N",
            "endpointDescription": "snickerson122803@direct.carilionclinic.org",
            "address_1": "3 Riverside Cir",
            "city": "Roanoke",
            "state": "VA",
            "country_code": "US",
            "postal_code": "240164955",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jerome Tak Nichols, M.D.
• Joshua Clayton Nichols, M.D.
• Synethia Mason Nichols, M.ED.
• Tammy Fox Nichols
• Tommie Jo Nichols, R.PH.
• Terry Paul Nickerson, MD
• Sarah Nie, M.D.
• James R Niederlehner, M.D.
• Mary C Niederlehner, RN, CRNA
• Jessica Marie Niedermeier, LPC

• Family Nurse Practitioner in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.