Individual provider Active NPI

Barbara Lynn Niklas, MSN, CPNP

  • Pediatric Nurse Practitioner
  • Brea, CA
National Provider Identifier
1053446617
Registry record updated Nov 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
RN318310 Issued in CA
Practice address
955 W Imperial Hwy Ste 200
Brea, CA 92821-3812
Phone
(714) 671-0766
NPI assigned
Feb 23, 2007
Last updated
Nov 9, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X RN318310 CA Primary

Addresses

Primary practice location

955 W Imperial Hwy Ste 200
Brea, CA 92821-3812

Mailing address

2410 Redcoach LN
La Habra, CA 90631-6254
Phone (562) 694-3694

Other practice location 1

2720 N Harbor Blvd
Suite 300
Fullerton, CA 92835-2609
Phone (714) 449-6990

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bniklas1374312@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051115000528 CA Practitioner - Nurse Practitioner 2567481948 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN318310CAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Aug 31, 2017 Accepting new patients
St Jude Hospital Inc Past Accepting new patients
Providence Medical Foundation Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 400
Anaheim, CA 92805

955 W Imperial Hwy
Ste 200
Brea, CA 92821
Phone (714) 449-6900

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

2720 N Harbor Blvd
Ste 300
Fullerton, CA 92835
Phone (657) 632-0123

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636416000000",
    "number": "1053446617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2410 REDCOACH LN",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "906316254",
            "telephone_number": "562-694-3694",
            "fax_number": "714-449-6971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 W IMPERIAL HWY STE 200",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928213812",
            "telephone_number": "714-671-0766"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2720 N Harbor Blvd",
            "address_2": "Suite 300",
            "address_purpose": "LOCATION",
            "city": "Fullerton",
            "state": "CA",
            "postal_code": "928352609",
            "country_code": "US",
            "telephone_number": "714-449-6990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIKLAS",
        "first_name": "BARBARA",
        "middle_name": "LYNN",
        "credential": "MSN, CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-23",
        "last_updated": "2021-11-09",
        "certification_date": "2021-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "RN318310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bniklas1374312@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "955 W Imperial Hwy Ste 200",
            "city": "Brea",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928213812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brea, CA

Sources for this page

Verify at the official NPI Registry.