Jacy Adam Nicholson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12011947A Issued in IN

Practice address

630 Kimmell Rd
Suite C
Vincennes, IN 47591-6330

Phone

(812) 316-2013

NPI assigned

May 22, 2013

Sex

Female

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

Enrolled in IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1369180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369180800000",
    "number": "1306282918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3676 W 200S",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475468200",
            "telephone_number": "812-661-0024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 KIMMELL RD",
            "address_2": "SUITE C",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475916330",
            "telephone_number": "812-316-2013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "JACY",
        "middle_name": "ADAM",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-22",
        "last_updated": "2013-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12011947A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Paige Nichols, RN
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• Teresa Jeanne Niehaus, OTR
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• Kevin Edward Nowakowski, MD
• Thomas Patrick O'Rourke, M.D.

• General Practice Dentistry in Vincennes, IN
• Providers in Vincennes, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2013; 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.