Provider Demographics
NPI:1952927956
Name:MCCARTHY, NICOLE (CLC, CBS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:CLC, CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 POLARIS ST APT A
Mailing Address - Street 2:
Mailing Address - City:SHEPPARD AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76311-4012
Mailing Address - Country:US
Mailing Address - Phone:701-380-4762
Mailing Address - Fax:
Practice Address - Street 1:210 POLARIS ST APT A
Practice Address - Street 2:
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311-4012
Practice Address - Country:US
Practice Address - Phone:701-380-4762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN