Katherine M. Nichols, APRN
Individual provider Active NPI Adult Psychiatric/Mental Health Clinical Nurse Specialist · North Stonington, CT
NPI 1013956366 · NPPES record last updated Nov 6, 2014
Key facts
- NPI
- 1013956366
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Psychiatric/Mental Health Clinical Nurse Specialist 364SP0809X
- License
- 5939 (CT)
- Practice address
- 75 Swantown HL
Stonington Institute
North Stonington, CT 06359-1022 - Phone
- (860) 535-1010
- Fax
- (860) 535-9076
- NPI assigned
- Jun 5, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160823000613 | CT | Practitioner - Certified Clinical Nurse Specialist (CNS) | 7012988504 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5939 | CT | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeast Medical Group, Inc. | Current |
Accepting new patients |
Locations
226 Mill Hill Ave
Ste 3
Bridgeport, CT 06610
Phone (203) 384-3394
194 Howard St
New London, CT 06320
Phone (860) 442-0564
95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Psychiatric/Mental Health Clinical Nurse Specialist | 364SP0809X | 5939 | CT | Yes |
Addresses
Primary practice location
75 Swantown HL
Stonington Institute
North Stonington, CT 06359-1022
Mailing address
75 Swantown HL
Stonington Insitute
North Stonington, CT 06359-1022
Phone (860) 535-1010
Other providers in North Stonington, CT
- Amanda Hill
- Kylie Hynes
- Kali Knight
- Little Oaks ABA
- Jessica Lombardi
- Angela P Noe
- Jody Elizabeth Noe
- North Stonington Ambulance Association, Inc
- North Stonington Board of Education
- North Stonington Health Center, Inc
All providers in North Stonington, CT · Adult Psychiatric/Mental Health Clinical Nurse Specialist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 6, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.