Provider Demographics
NPI:1053161174
Name:CARTER, NICHELLE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:NICHELLE
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:NICHELLE
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1868 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-4040
Mailing Address - Country:US
Mailing Address - Phone:518-258-3226
Mailing Address - Fax:
Practice Address - Street 1:5010 STATE HIGHWAY 30 STE G02
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7532
Practice Address - Country:US
Practice Address - Phone:518-842-0017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF353387-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily