Dominique Kiara Nickens

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA013747 Issued in OH

Practice address

9500 Broadview Rd
Broadview Heights, OH 44147-2302

Phone

(440) 596-3047

NPI assigned

Oct 7, 2026

Last updated

Oct 7, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1791331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791331200000",
    "number": "1093619439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6511 MARSOL RD APT 122",
            "city": "MAYFIELD HEIGHTS",
            "state": "OH",
            "postal_code": "441243542",
            "telephone_number": "216-413-6098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 BROADVIEW RD",
            "city": "BROADVIEW HEIGHTS",
            "state": "OH",
            "postal_code": "441472302",
            "telephone_number": "440-596-3047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKENS",
        "first_name": "DOMINIQUE",
        "middle_name": "KIARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-10-07",
        "last_updated": "2026-10-07",
        "certification_date": "2026-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "OH",
            "license": "PTA013747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Danielle Moore-Fruits
• Karen Ann Morrow
• Velvet Neffenger
• Christine Diane Nejdl, R.D.,L.D.
• Taylor Newlove-Chimes, RDN
• Nancy Nin
• Justin I Nixon, PTA
• Nutrition Works, LLC
• Lucy Kathleen O'Brien, D.O.
• Ashley Osterman, FNP-BC

• Physical Therapy Assistant in Broadview Heights, OH
• Providers in Broadview Heights, OH by specialty
• Physical Therapy Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.