Lakeisha N Nicholls, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F347444 Issued in NY

Practice address

255 E Houston St
New York, NY 10002-1013

Phone

(212) 477-1120

Fax

(212) 477-8957

NPI assigned

Oct 31, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NJ, NY2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sun River Health Inc.Group PAC ID 6608783568, shared by 3 NPIs, 246 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Bergen County Improvement Authority

  dba Bergen New Bridge Medical Center Medical Provider Group

  • Internal Medicine Physician
  • Paramus, NJ
  • NPI 1891836441
  Medicare reassignment NPD
• Bergen County Improvement Authority

  dba Bergen New Bridge Medical Center

  • Psychiatric Hospital Unit
  • Paramus, NJ
  • NPI 1952456295
  NPD
• Community Healthcare Network, Inc.

  dba Phoenix School Based Health Center

  • Federally Qualified Health Center (FQHC)
  • New York, NY
  • NPI 1912436858
  NPD (past)

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711497600000",
    "number": "1154407096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 BROADWAY STE 136",
            "city": "WESTWOOD",
            "state": "NJ",
            "postal_code": "076751674",
            "telephone_number": "551-265-4342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 E HOUSTON ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100021013",
            "telephone_number": "212-477-1120",
            "fax_number": "212-477-8957"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1167 Nostrand Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112255417",
            "country_code": "US",
            "telephone_number": "718-778-0198",
            "fax_number": "718-221-8169",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "999 Blake Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112083535",
            "country_code": "US",
            "telephone_number": "718-277-8303",
            "fax_number": "718-277-4795",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2581 Atlantic Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112072412",
            "country_code": "US",
            "telephone_number": "718-495-6700",
            "fax_number": "646-988-2840",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "504 W 158th St Fl 5",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100327202",
            "country_code": "US",
            "telephone_number": "917-521-3130 x3130",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "94-98 Manhattan Avenue",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "11206",
            "country_code": "US",
            "telephone_number": "718-388-0390",
            "fax_number": "718-486-5741",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4215 3rd Ave Fl 2",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104574501",
            "country_code": "US",
            "telephone_number": "718-294-5891",
            "fax_number": "718-294-2468",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "975 Westchester Ave",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104593204",
            "country_code": "US",
            "telephone_number": "718-320-4466",
            "fax_number": "718-991-3829",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "36-11 21st St",
            "address_purpose": "LOCATION",
            "city": "Long Island City",
            "state": "NY",
            "postal_code": "111064505",
            "country_code": "US",
            "telephone_number": "718-482-7772",
            "fax_number": "718-482-9648",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "89-44 164th St",
            "address_purpose": "LOCATION",
            "city": "Jamaica",
            "state": "NY",
            "postal_code": "114326103",
            "country_code": "US",
            "telephone_number": "718-523-2123",
            "fax_number": "718-523-5833",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "350 Grand St Rm 240",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100024629",
            "country_code": "US",
            "telephone_number": "212-634-7550 x7556",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "511 W 157TH ST",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100325058",
            "country_code": "US",
            "telephone_number": "212-781-7979",
            "fax_number": "212-781-7963",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "81 W 115th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100263138",
            "country_code": "US",
            "telephone_number": "212-426-0088",
            "fax_number": "212-426-8367",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "700 Broadway Ste 136",
            "address_purpose": "LOCATION",
            "city": "Westwood",
            "state": "NJ",
            "postal_code": "076751674",
            "country_code": "US",
            "telephone_number": "551-265-4342",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICHOLLS",
        "first_name": "LAKEISHA",
        "middle_name": "N",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-31",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "F381608",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ01194600",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F347444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "drnicholls@compassionateprimarycare.com",
            "affiliation": "N",
            "address_1": "700 Broadway Ste 136",
            "city": "Westwood",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "076751674",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alvin Nicholas, PHD
• Catherine Nicholas, LCSW
• Emily Nicholas, LCSW
• Jansen Nicholas, PT, DPT
• Michaela Nicholas
• Nancy Jane Nichols-Goldstein, PSY.D.
• Brent Nichols, M.A., L.C.S.W.
• Cassie Nichols, LPN
• Christiana Celeste Nichols, MD
• Christina Nichols, PH.D.

• Family Nurse Practitioner in New York, NY
• Providers in New York, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.