Amanda Nicholson, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

20160539 Issued in LA

Practice address

161 Comeaux Rd.
Rayville, LA 71269

Phone

(318) 402-3338

NPI assigned

Nov 25, 2020

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Second Chances Recovery Center LLC

  • Substance Abuse Rehabilitation Facility
  • Rayville, LA
  • NPI 1073122420
  NPD

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

{
    "created_epoch": "1606262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606262400000",
    "number": "1124622683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 COMEAUX RD",
            "city": "RAYVILLE",
            "state": "LA",
            "postal_code": "71269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 COMEAUX RD.",
            "city": "RAYVILLE",
            "state": "LA",
            "postal_code": "71269",
            "telephone_number": "318-402-3338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "AMANDA",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-25",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "LA",
            "license": "20160539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ademere@secondchancesrehab.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "161 Comeaux Rd.",
            "city": "Rayville",
            "state": "LA",
            "country_code": "US",
            "postal_code": "71269",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ashley Moore
• Sam L. Moore III, M. ED
• Elnora Danielle Myles
• Roderick Myles I
• Charmetta Kay Nash
• Northeast la. Substance Abuse Clinic
• Northeast Louisiana Physical Therapy, LLC
• Osteoporosis Imaging Center
• Lisa Nicole Pace, CD
• Sonya Denae Pailette, LOTR

• Licensed Practical Nurse in Rayville, LA
• Providers in Rayville, LA by specialty
• Licensed Practical Nurse in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; 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.