Provider Demographics
NPI:1689260499
Name:RAHENKAMP, NICHOLE ANN (NP)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:ANN
Last Name:RAHENKAMP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:ANN
Other - Last Name:BOSTICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 935983
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-5983
Mailing Address - Country:US
Mailing Address - Phone:336-277-8800
Mailing Address - Fax:336-277-8850
Practice Address - Street 1:1010 BETHESDA CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3019
Practice Address - Country:US
Practice Address - Phone:336-277-8800
Practice Address - Fax:336-277-8850
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF12200448363LF0000X
NC5013978363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily