Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. NICOLE POYTHRESS WATERS, DO, PHD
ActiveDR. NICOLE POYTHRESS WATERS, DO, PHD is a Family Medicine healthcare provider located in CARRIER MILLS, Illinois. NPI 1407416308 is currently active in the NPPES registry. Verify at CMS.
Family Medicine · CARRIER MILLS, IL
Registration Details
- NPI Number
- 1407416308
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Jun 13, 2019 (7.2178576784279 yrs)
- Last Updated
- Feb 6, 2026
- License
-
036157809 (IL)
Practice Information
- Address
-
7211 US 45 SCARRIER MILLS, IL, 629171305Browse IL providers · Browse ZIP 62917
- Phone
- 6182948247
- Fax
- 6182948247
- Primary Specialty
-
Family Medicine
207Q00000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.