Ann Louise Nicely, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

464 Issued in WV

Practice address

60 Roxbury Rd
Whitehall Medical, PLLC
Fairmont, WV 26554-8223

Phone

(304) 363-6600

Fax

(304) 363-7700

NPI assigned

Jan 25, 2007

Last updated

May 6, 2009By 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 2

Other names 1

• Ann L Nicely Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241568000000",
    "number": "1265588271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 ROXBURY RD",
            "address_2": "WHITEHALL MEDICAL, PLLC",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265548223",
            "telephone_number": "304-363-6600",
            "fax_number": "304-363-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 ROXBURY RD",
            "address_2": "WHITEHALL MEDICAL, PLLC",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265548223",
            "telephone_number": "304-363-6600",
            "fax_number": "304-363-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICELY",
        "first_name": "ANN",
        "middle_name": "LOUISE",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2009-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "00375",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WV WORKER'S COMP",
            "identifier": "S99643",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00455326",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANN",
            "last_name": "NICELY",
            "middle_name": "L",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Melissa Ann Nestor
• Wyatt Nett, DPT
• Armon J Nettey
• Kathy Newbraugh
• Meagan Newhouse
• Ryan Nichols, PHARMD
• Kira Leigh Nixon, COTA
• Sara Marie Nixon, PTA 002602
• Noble Behavior Steps
• Kathy Noble

• Physician Assistant in Fairmont, WV
• Providers in Fairmont, WV by specialty
• Physician Assistant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2009; 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.