Basic Information
| Provider Information | |||||||||
| NPI: | 1427140631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174218 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 N 7TH ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172631220 | ||||||||
| FaxNumber: | 7172636255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 09/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA052694 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AS0400X | MA052694 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 50111456 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 8552892 | 01 | PA | AETNA HMO | OTHER | 8552893 | 01 | PA | AETNA HMO | OTHER | MM1504263 | 01 | PA | DEA | OTHER | 103146271 | 05 | PA | MEDICAID | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | 50111454 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 9715533 | 01 | PA | AETNA NON HMO | OTHER | MA052694 | 01 | PA | LICENSE | OTHER | 50063906 | 01 | PA | CAPITAL BC | OTHER | 50074345 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 6622483 | 01 | PA | AETNA HMO | OTHER |