Robert A. Nickelson, M.D.

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

015593 Issued in LA

Practice address

2600 Kings Hwy
Suite 340
Shreveport, LA 71103

Phone

(318) 212-8620

Fax

(318) 212-8625

NPI assigned

Aug 1, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197936000000",
    "number": "1023019064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 KINGS HWY",
            "address_2": "SUITE 340",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71103",
            "telephone_number": "318-212-8620",
            "fax_number": "318-212-8625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 KINGS HWY",
            "address_2": "SUITE 340",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71103",
            "telephone_number": "318-212-8620",
            "fax_number": "318-212-8625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKELSON",
        "first_name": "ROBERT",
        "middle_name": "A.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-01",
        "last_updated": "2007-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "LA",
            "license": "015593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1322741",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Morgan Nichols, LMSW
• Perry Duane Nichols, FNP
• Barney Mathews Nicholson Jr., MD
• Quasean Nicholson, MENTAL HEALTH SPECIA
• Carylon Nickelberry
• Lisa H. Nicoletti, DNP, APRN, FNP-BC
• Kristan Nielsen Belcher, R.N.
• Daphne Lane Nierman
• Jacalyn Nierman
• Ronald Gilbert Nierman, LPC

• Hematology & Oncology Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Hematology & Oncology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.