Provider Demographics
NPI:1669985362
Name:CARLTON, NICHOLE RENEE (PA-C)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:RENEE
Last Name:CARLTON
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 1:166 E VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:OH
Mailing Address - Zip Code:44672-1443
Mailing Address - Country:US
Mailing Address - Phone:330-257-2916
Mailing Address - Fax:
Practice Address - Street 1:1509 DOCTORS CIR BLDG C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7403
Practice Address - Country:US
Practice Address - Phone:910-662-7500
Practice Address - Fax:910-662-7501
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005282RX207T00000X, 363AM0700X
NC0010-14992363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical