Kimberly Nicholson

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

1700 McHenry Village Way Ste 11B
Modesto, CA 95350-4341

Phone

(209) 550-5850

NPI assigned

Mar 12, 2024

Sex

Female

Sole proprietor

Yes

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

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

{
    "created_epoch": "1710201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1124886379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 POPLAR AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953540510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 MCHENRY VILLAGE WAY STE 11B",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504341",
            "telephone_number": "209-550-5850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "KIMBERLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-12",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Poblete, D.D.S., Inc.
• Michael Nicholas
• Danielle Nicholls
• Samuel Nichols III
• Kelley Anne Nicholson
• Maria G Nico-Alejo
• Debbie M Nicolodi
• Viviana Nides
• Lindsey Joy Nielsen, PMHNP-BC
• Lauren Nielson

• Community Health Worker in Modesto, CA
• Providers in Modesto, CA by specialty
• Community Health Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; 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.