HEATHER NICKERSON (NPI# 1669889481) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669889481 |
| Entity Type | Individual |
| Full Name | HEATHER NICKERSON |
| Credential | MS PA-C |
| Practice Address |
365 Montauk Ave New London CT 06320-4700 |
| Mailing Address |
39 Corrine Dr East Falmouth MA 02536-2708 |
| Practice Telephone | 5085600011 |
| Mailing Telephone | 5085600011 |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2014-07-14 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
3135 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073029542 | Heather Nickerson | Behavior Technician | 3978 Sorrento Valley Blvd, San Diego, CA 92121-1436 | 2017-12-20 |
| 1275809170 | Heather Nickerson | Counselor | 600 Medical Dr, Ste A & B, Hampton, VA 23666-1769 | 2012-03-26 |
| Street Address |
365 MONTAUK AVE |
| City | NEW LONDON |
| State | CT |
| Zip Code | 06320-4700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568460186 | Steven Lu | Internal Medicine | 365 Montauk Ave, Rm 4.512, New London, CT 06320-4700 | 2005-07-08 |
| 1407471246 | Lawrence and Memorial Hospital, Inc. | Internal Medicine | 365 Montauk Ave, New London, CT 06320-4700 | 2020-06-08 |
| 1952954117 | Veronica O Lee | Pharmacist | 365 Montauk Ave, New London, CT 06320-4700 | 2019-07-17 |
| 1265084487 | Lydia Derienzo | Pharmacist | 365 Montauk Ave, New London, CT 06320-4700 | 2019-07-09 |
| 1184283699 | Theresa Joan Crino | Pharmacist | 365 Montauk Ave, New London, CT 06320-4700 | 2019-06-08 |
| 1437718137 | Linda Anderson | Pharmacist | 365 Montauk Ave, New London, CT 06320-4769 | 2019-06-07 |
| 1265091813 | Stephen Richard Cofone | Pharmacist | 365 Montauk Ave, New London, CT 06320-4700 | 2019-06-07 |
| 1841859683 | Thomas David Page | Pharmacist | 365 Montauk Ave, New London, CT 06320-4769 | 2019-06-06 |
| 1942869706 | William Edward Sergiy IIi | Pharmacist | 365 Montauk Ave, New London, CT 06320-4700 | 2019-06-06 |
| 1578122263 | Mary Stevens | Pharmacist | 365 Montauk Ave, New London, CT 06320-4700 | 2019-06-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942824891 | Shilpi Jain | Physical Therapist | 31 Vauxhall Street, Beechwood Post Accute, Transitional, New London, CT 06320 | 2020-06-05 |
| 1174009641 | Catherine Hinojosa | Nurse Practitioner | 1 Shaws Cove, New London, CT 06320 | 2018-07-17 |
| 1043668320 | Cultivate & Grow Inc. | Counselor | 302 State St Suite 307, New London, CT 06320 | 2016-05-27 |
| 1295137263 | Jacqueline Durnell | Registered Nurse | 15 Mohegan Drive, Us Coast Guard Academy Regional Clinic, New London, CT 06320 | 2014-09-22 |
| 1922427541 | Corina Vendetto | Registered Nurse | 245 Shaw St., New London, CT 06320 | 2014-04-10 |
| 1912329962 | Janelle Posey-green | Social Worker | 302 State St., Suite 201, New London, CT 06320 | 2014-01-10 |
| 1750622692 | Cynthia Mitchell | Social Worker | 65b Michael Rd, New London, CT 06320 | 2013-03-01 |
| 1518254507 | Simon J Shapiro | Physical Medicine & Rehabilitation | 190 Howard Avenue, New London, CT 06320 | 2011-06-29 |
| 1184876708 | Jane P Genido-trujillo | Nurse Practitioner | 270 Mohegan Ave., Student Health Services, New London, CT 06320 | 2008-10-14 |
| 1932356284 | Gerard Joseph Ventura | Dentist | 21 Montauk Ave., Suite 102, New London, CT 06320 | 2008-08-19 |
| Find all providers in zip 06320 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558319194 | Arthur S Welch | Physician Assistant | 50 Fair Harbour Pl, Suite 2-a, New London, CT 06320-4731 | 2006-05-05 |
| 1629074505 | Jan Idzikowski | Physician Assistant | 273 County Rd, New London, NH 03257-5736 | 2005-06-24 |
| 1508429275 | Marissa Ann Sylvester | Physician Assistant | 365 Montauk Ave, New London, CT 06320-4700 | 2019-04-18 |
| 1295213320 | Kelsey Bestall | Physician Assistant | 365 Montauk Ave, New London, CT 06320-4700 | 2018-07-31 |
| 1669809927 | L&m Medical Group | Physician Assistant | 365 Montauk Ave, New London, CT 06320-4700 | 2013-10-02 |
| 1699910489 | Taryn Fabian | Physician Assistant | 365 Montauk Ave, New London, CT 06320-4700 | 2008-12-08 |
| 1669684205 | Margo R. Coffey | Physician Assistant | 365 Montauk Ave, New London, CT 06320-4700 | 2007-05-04 |
| 1326182650 | Juan C Delprado | Physician Assistant | 365 Montauk Ave, New London, CT 06320-4700 | 2007-02-19 |
| 1275696304 | Marcelle Loranger Cashman | Physician Assistant | 365 Montauk Ave, New London, CT 06320-4700 | 2006-12-19 |
| 1134132244 | Jenine Decaprio Gesino | Physician Assistant | 365 Montauk Ave, New London, CT 06320-4700 | 2006-08-14 |
| Find all providers in NEW LONDON | ||||
| City | NEW LONDON |
| Zip Code | 06320 |
Please comment or provide details below to improve the information on HEATHER NICKERSON.
| 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.