Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Nicole Vital, PA-C

Individual provider Physician Assistant · NPI 1720536378

Nicole Vital, PA-C is a Physician Assistant in Matthews, North Carolina. Qualified in 2016, 10 years ago. Practices with Carolina Medicorp Enterprises LLC, a 185-clinician group, works from 2 locations and accepts Medicare assignment.

Years since qualifying
10
In the registry since
2016
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

9600 E Independence Blvd Ste B
Matthews, NC 28105-4628
Phone: (704) 815-5624
Fax: (704) 815-5621
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 445 S Kings Dr, Charlotte, NC 28204-3041 — (980) 308-0141

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1720536378
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 12, 2016
Last updated in NPPESAugust 3, 2021
Certification dateAugust 3, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Carolina Medicorp Enterprises Llc — 185 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations13 on file with Medicare

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