Provider Demographics
NPI:1689260499
Name:RAHENKAMP, NICHOLE ANN (NP)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:ANN
Last Name:RAHENKAMP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:ANN
Other - Last Name:BOSTICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1730 KERNERSVILLE MEDICAL PKWY STE 101
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7198
Practice Address - Country:US
Practice Address - Phone:336-564-4950
Practice Address - Fax:336-564-4959
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF12200448363LF0000X
NC5013978363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily