Active NPI
Regina Shanelle Nickelson, FNP-BC
- Nurse Practitioner
- Meridian, MS
National Provider Identifier
1083844526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 1-099036
- Practice address
- 2701 Davis Street
Meridian, MS 39301-5708 - Phone
- (601) 693-0118
- Fax
- (601) 553-8175
- NPI assigned
- Jul 17, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 1-099036 | AL | Primary |
Addresses
Primary practice location
2701 Davis Street
Meridian, MS 39301-5708
Mailing address
2701 Davis Street
Meridian, MS 39301-5708
Phone (601) 693-0118
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R865667 | Other | MS | BOARD OF NURSING |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-099036 | AL | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352246400000",
"number": "1083844526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2701 DAVIS STREET",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "393015708",
"telephone_number": "601-693-0118",
"fax_number": "601-553-8175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2701 DAVIS STREET",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "393015708",
"telephone_number": "601-693-0118",
"fax_number": "601-553-8175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKELSON",
"first_name": "REGINA",
"middle_name": "SHANELLE",
"credential": "FNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-17",
"last_updated": "2012-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "AL",
"license": "1-099036",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF NURSING",
"identifier": "R865667",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Meridian, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.