Active NPI
Jourdan Nichols
- Early Intervention Provider Agency
- Fulton, MO
National Provider Identifier
1154715316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Early Intervention Provider Agency
- License
- 2015001098
- Practice address
- 2 Hornet Dr
Fulton, MO 65251-2732 - Phone
- (573) 590-8000
- NPI assigned
- Mar 26, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Early Intervention Provider Agency | 252Y00000X | 2015001098 | MO | Primary |
Addresses
Primary practice location
2 Hornet Dr
Fulton, MO 65251-2732
Mailing address
2 Hornet Dr
Fulton, MO 65251-2732
Phone (573) 590-8000
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2015001098 | MO | MD | Early Intervention Provider Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427328000000",
"number": "1154715316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 HORNET DR",
"city": "FULTON",
"state": "MO",
"postal_code": "652512732",
"telephone_number": "573-590-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 HORNET DR",
"city": "FULTON",
"state": "MO",
"postal_code": "652512732",
"telephone_number": "573-590-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "JOURDAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-03-26",
"last_updated": "2015-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "252Y00000X",
"taxonomy_group": "",
"desc": "Early Intervention Provider Agency",
"state": "MO",
"license": "2015001098",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fulton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.