Kelly L Nicholson, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1340 Issued in SC

Legal business name

KELLY L NICHOLSON, PSYD

Practice address

19 Shelter Cove LN
Hilton Head Island, SC 29928-3520

Phone

(843) 226-6690

NPI assigned

Aug 21, 2015

Last updated

Aug 21, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kelly L Nicholson, PSYDNPI 1043424807

Title

Psychologist

Phone

(843) 226-6690

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelly L Nicholson, PSY.D.

  • Clinical Psychologist
  • Castle Rock, CO
  • NPI 1043424807

  SC

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1440115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440115200000",
    "number": "1285001560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 REDBUD WAY",
            "city": "BLUFFTON",
            "state": "SC",
            "postal_code": "299105605",
            "telephone_number": "843-226-6690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 SHELTER COVE LN",
            "city": "HILTON HEAD ISLAND",
            "state": "SC",
            "postal_code": "299283520",
            "telephone_number": "843-226-6690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY L NICHOLSON, PSYD",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-21",
        "last_updated": "2015-08-21",
        "status": "A",
        "authorized_official_last_name": "NICHOLSON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "843-226-6690",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "SC",
            "license": "1340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sathwik Katragadda, MD
• Courtney A Kauk, PT
• John J Kelemen III, M.D.
• Kinsey Lynn Keller, LPC
• Kelley Chiropractic, LLC
• Jessica Leigh Kelly, RPH
• Michael E Kennedy, PT
• Martin H Kerr, M.S.,P.T.
• Benjamin J Kessler, DO
• Angela Ward Keziah

• Clinical Psychologist in Hilton Head Island, SC
• Providers in Hilton Head Island, SC by specialty
• Clinical Psychologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.