Nicole M. Gullickson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

11974 Issued in ND

Practice address

2400 32ND Ave S
Fargo, ND 58103-5800

Phone

(701) 234-8800

NPI assigned

Jun 12, 2008

Last updated

Jan 19, 2012By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nicolegullickson@wrhs.allscriptsdirect.net

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

• University of North Dakota

  • Family Medicine Physician
  • Bismarck, ND
  • NPI 1619905528
  Medicare reassignment NPD
• West River Health Services

  dba Hettinger Clinic

  • Critical Access Hospital Clinic/Center
  • Hettinger, ND
  • NPI 1174606271
  Medicare reassignment NPD
• West River Health Services

  dba West River Regional Medical Center

  • Critical Access Hospital
  • Hettinger, ND
  • NPI 1588763247
  Medicare reassignment NPD
• University of North Dakota

  dba Center for Family Medicine - Minot

  • Family Medicine Physician
  • Minot, ND
  • NPI 1316008238
  NPD
• University of North Dakota

  • Clinic/Center
  • Grand Forks, ND
  • NPI 1952969099
  NPD
• West River Health Services

  dba West River Regional Medical Center

  • Physical Therapy Clinic/Center
  • Mott, ND
  • NPI 1902526411
  NPD

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

{
    "created_epoch": "1213228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326931200000",
    "number": "1174783211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 32ND AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581035800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 32ND AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581035800",
            "telephone_number": "701-234-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULLICKSON",
        "first_name": "NICOLE",
        "middle_name": "M.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-12",
        "last_updated": "2012-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "R-8325",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "11974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16268",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Guiding Light Counseling and Consulting PLLC
• Carissa Guler, O.D.
• Madison Mae Guler
• James Merle Gullekson, LMT
• Jean L Gullicks, APRN, FNP
• Shannon Lynn Gullingsrud, PA-C
• Alisha Gumbleton
• Aaron C Gunderson, MD
• Carrie L Gunderson
• Dean Emmett Gunderson

• Family Medicine Physician in Fargo, ND
• Providers in Fargo, ND by specialty
• Family Medicine Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.