Kristen Nichols, SLP-PCE

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

PCET003032 Issued in GA

Practice address

534 Owl Creek Dr
Powder Springs, GA 30127-6285

Phone

(770) 361-4124

Fax

(678) 290-5587

NPI assigned

Sep 25, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Mobility Physical Therapy

  • Rehabilitation Clinic/Center
  • Powder Springs, GA
  • NPI 1689817850

  Speech-Language Pathologist

  NPD (past)

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

{
    "created_epoch": "1569369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569369600000",
    "number": "1285285718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "534 OWL CREEK DR",
            "city": "POWDER SPRINGS",
            "state": "GA",
            "postal_code": "301276285",
            "telephone_number": "770-361-4124",
            "fax_number": "678-290-5587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "534 OWL CREEK DR",
            "city": "POWDER SPRINGS",
            "state": "GA",
            "postal_code": "301276285",
            "telephone_number": "770-361-4124",
            "fax_number": "678-290-5587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "KRISTEN",
        "credential": "SLP-PCE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-25",
        "last_updated": "2019-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "PCET003032",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000869096E",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kris.pt@kidsmpt.com",
            "affiliation": "N",
            "address_1": "534 Owl Creek Dr",
            "city": "Powder Springs",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301276285",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Speech-Language Pathologist in Powder Springs, GA
• Providers in Powder Springs, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; 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.