NICOLE M MACK (NPI# 1386031094) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386031094 |
| Entity Type | Individual |
| Full Name | NICOLE M MACK |
| Other Name | NICOLE M JOHNSON |
| Practice Address |
618 W Academy St Canton MS 39046-4225 |
| Practice Telephone | 7692513329 |
| Mailing Telephone | 7692513329 |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2016-02-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 372600000X | Adult Companion | Nursing Service Related Providers | ||
| Y | 3747P1801X |
Technician Specialization: Personal Care Attendant |
Nursing Service Related Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316503147 | Nicole Mack | Speech-Language Pathologist | 1660 E Booker Dairy Rd, Smithfield, NC 27577-9405 | 2019-05-16 |
| 1952547549 | Nicole Mack | Speech-Language Pathologist | 1 Diamond Hill Rd, Berkeley Heights, NJ 07922-2104 | 2009-01-02 |
| Street Address |
618 W ACADEMY ST |
| City | CANTON |
| State | MS |
| Zip Code | 39046-4225 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043858053 | Pediatric Haven | Skilled Nursing Facility | 112 Westfalen Drive, Canton, MS 39046 | 2019-12-20 |
| 1932743176 | Stacey Elizabeth Aldridge | Social Worker | 210 E Peace Street, Canton, MS 39046 | 2019-10-31 |
| 1881245736 | Mildred Loving | Technician | 323 Shady Lane, Canton, MS 39046 | 2019-09-23 |
| 1295384683 | Betty Bass | Technician | 693 Miggins Road, Canton, MS 39046 | 2019-09-09 |
| 1972081644 | Charles Brayden Jones | Physical Therapist | 276 Nissan Pkwy Ste 400, Canton, MS 39046 | 2018-08-03 |
| 1013436062 | Andrew J Breland | Counselor | 210 E Peace St, Canton, MS 39046 | 2017-09-11 |
| 1801318290 | Mississippi Enjoy Breastfeeding Shalom Resource Center | Clinic/Center | 343 Smith Street, Canton, MS 39046 | 2017-07-07 |
| 1619362977 | Shameca Hudson | Nurse Practitioner | 274 Cobbville Dr E, Canton, MS 39046 | 2015-04-03 |
| 1144644386 | Margaret Reimers Beckwith | Chiropractor | 124 Links Drive, I-103, Canton, MS 39046 | 2014-02-07 |
| 1053753194 | Tanya Linette Calhoun | Nurse Practitioner | 1171 Hart Street, Canton, MS 39046 | 2013-07-17 |
| Find all providers in zip 39046 | ||||
| Taxonomy Code | 3747P1801X |
| Grouping | Nursing Service Related Providers |
| Classification | Technician |
| Specialization | Personal Care Attendant |
| An individual who provides assistance with eating, bathing, dressing, personal hygiene, activities of daily living as specified in the plan of care. Services which are incidental to the care furnished, or essential to the health and welfare of the individual may also be provided. Personal care providers must meet state defined training and certification standards |
| Notes: [7/1/2003: definition added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134729783 | Tyla Cundiff | Technician | 1317 Warrick Pl Ne, Canton, OH 44714-1864 | 2020-10-31 |
| 1346847829 | Natasha M Overstreet | Technician | 702 Fulton Rd Nw, Canton, OH 44703-2319 | 2020-10-07 |
| 1457961591 | Ashley Palmer | Technician | 1818 Trinity Pl Nw Apt 64, Canton, OH 44709-3360 | 2020-08-04 |
| 1912515271 | Sabrina Patterson | Technician | 2315 41st St Ne, Canton, OH 44705-2803 | 2020-07-22 |
| 1609497536 | Loving Care Home Care of Canton LLC | Technician | 5860 N Canton Center Rd Ste 306, Canton, MI 48187-2687 | 2020-05-01 |
| 1629620703 | Sherri Denise Mayer | Technician | 2235 13th St Ne, Canton, OH 44705-1919 | 2019-07-10 |
| 1124686431 | Tiffany La'shae Brown | Technician | 716 30th St Nw Apt 214, Canton, OH 44709-3162 | 2019-05-31 |
| 1184196404 | Roseanna Lea Durnell | Technician | 12417 Fm 1651, Canton, TX 75103-4023 | 2018-12-27 |
| 1669940086 | Ashley Faithlyn Palmer | Technician | 6136 Cedar Ln Nw, Canton, OH 44708-1156 | 2018-11-02 |
| 1144768110 | Kiona Moody | Technician | 3136 Gilbert Circle, Canton, OH 44705-4264 | 2017-02-09 |
| Find all providers in CANTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.