Active NPI
Tracy Lynn Nichols, PT
- Physical Therapist
- Van Buren, AR
National Provider Identifier
1003215351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 1369
- Practice address
- 117 Northridge Dr Ste C
Van Buren, AR 72956-6983 - Phone
- (479) 431-7460
- NPI assigned
- Aug 21, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2566 | OK | |
| Physical Therapist | 225100000X | PT 1369 | AR | Primary |
Addresses
Primary practice location
117 Northridge Dr Ste C
Van Buren, AR 72956-6983
Mailing address
1515 Trenton Cir
Van Buren, AR 72956-2838
Phone (479) 431-7460
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2566 | OK | MD | Optometrist |
| PT 1369 | AR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648252800000",
"number": "1003215351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1515 TRENTON CIR",
"city": "VAN BUREN",
"state": "AR",
"postal_code": "729562838",
"telephone_number": "479-431-7460",
"fax_number": "479-785-8564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 NORTHRIDGE DR STE C",
"city": "VAN BUREN",
"state": "AR",
"postal_code": "729566983",
"telephone_number": "479-431-7460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "TRACY",
"middle_name": "LYNN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-21",
"last_updated": "2022-03-26",
"certification_date": "2022-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OK",
"license": "2566",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AR",
"license": "PT 1369",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Van Buren, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.