Active NPI
Deandre Nichols
- Rehabilitation Practitioner
- North Las Vegas, NV
National Provider Identifier
1013372663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 3755 W Lake Mead Blvd
North Las Vegas, NV 89032-4897 - Phone
- (702) 487-5665
- NPI assigned
- Dec 28, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | NV | Primary |
Addresses
Primary practice location
3755 W Lake Mead Blvd
North Las Vegas, NV 89032-4897
Mailing address
4325 W Rome Blvd
Apt #2014
North Las Vegas, NV 89084-5497
Phone (323) 649-7196
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Nevada Children First | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Las Vegas, NV
- NPI 1437384229
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1451260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451260800000",
"number": "1013372663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4325 W ROME BLVD",
"address_2": "APT #2014",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890845497",
"telephone_number": "323-649-7196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3755 W LAKE MEAD BLVD",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890324897",
"telephone_number": "702-487-5665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "DEANDRE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-12-28",
"last_updated": "2015-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "NV",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.