Barney Mathews Nicholson Jr., MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

G 74505 Issued in CA

Practice address

510 E Stoner Ave
Shreveport, LA 71101-4243

Phone

(318) 990-4989

NPI assigned

Oct 28, 2005

Sex

Male

Sole proprietor

No

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670371200000",
    "number": "1205827334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10715 LONGFELLOW TRCE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711069340",
            "telephone_number": "601-559-9770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 E STONER AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014243",
            "telephone_number": "318-990-4989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "BARNEY",
        "middle_name": "MATHEWS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-28",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "G 74505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Walton Nichols, MD
• Latosha D'Ann Nichols, APRN-CNP
• Marilyn Nichols, LPN
• Morgan Nichols, LMSW
• Perry Duane Nichols, FNP
• Quasean Nicholson, MENTAL HEALTH SPECIA
• Carylon Nickelberry
• Robert A. Nickelson, M.D.
• Lisa H. Nicoletti, DNP, APRN, FNP-BC
• Kristan Nielsen Belcher, R.N.

• Surgery Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Surgery Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; 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.