Provider Demographics
NPI:1427140631
Name:MYERS, NICOLE E (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:E
Last Name:MYERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4218
Practice Address - Street 1:120 N 7TH ST STE 101
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1795
Practice Address - Country:US
Practice Address - Phone:717-263-1220
Practice Address - Fax:717-263-6255
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052694363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50111456OtherCAPITAL BLUE CROSS
PA8552892OtherAETNA HMO
PA8552893OtherAETNA HMO
PA103146271Medicaid
PA867633OtherMEDICARE GROUP #
PA50111454OtherCAPITAL BLUE CROSS
PA9715533OtherAETNA NON HMO
PAMA052694OtherLICENSE
PA50063906OtherCAPITAL BC
PA50074345OtherCAPITAL BLUE CROSS
PA6622483OtherAETNA HMO
PA6622483OtherAETNA HMO
PA8552892OtherAETNA HMO
PAQ74000Medicare UPIN
PAP00372371Medicare PIN
PAMM1504263OtherDEA
PA6622483OtherAETNA HMO