Provider Demographics
NPI:1912670274
Name:MCCRARY, NICOLETTE HUNEYCUTT (APRN)
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:HUNEYCUTT
Last Name:MCCRARY
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22738 MAPLE RD STE 214
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-3348
Mailing Address - Country:US
Mailing Address - Phone:704-472-8303
Mailing Address - Fax:
Practice Address - Street 1:22738 MAPLE RD STE 214
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-3348
Practice Address - Country:US
Practice Address - Phone:240-237-8268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-31
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015481363LF0000X
CA95017891363LF0000X
MDAC004644363LF0000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily