Gary Glenn Nichols, P.A.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

100253 Issued in NC

Practice address

1404 Willow LN
North Wilkesboro, NC 28659-3584

Phone

(336) 667-0335

Fax

(336) 667-4434

NPI assigned

Oct 14, 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

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: gnichols2755298@carolinashealthcaresystem.direct-ci.com

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.

• Greenway Healthcare, PLLC

  • Internal Medicine Physician
  • N Wilkesboro, NC
  • NPI 1184719072
  NPD (past)
• Kenneth F Curl

  • Internal Medicine Physician
  • N Wilkesboro, NC
  • NPI 1932330552
  NPD (past)
• Wilkes Physician Network, Inc.

  dba Greenway Healthcare

  • Internal Medicine Physician
  • North Wilkesboro, NC
  • NPI 1710202429
  NPD (past)

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501545600000",
    "number": "1316936156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602658",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602658",
            "telephone_number": "336-716-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 WILLOW LN",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286593584",
            "telephone_number": "336-667-0335",
            "fax_number": "336-667-4434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "GARY",
        "middle_name": "GLENN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-14",
        "last_updated": "2017-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "100253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN, INDIVIDUAL",
            "identifier": "2750028C",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5905127",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "203994F",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN, GROUP",
            "identifier": "2335816",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alisha Nance
• Marguinia Lynn Nance, M.A.
• New River Mental Health Center (New River Behavioral HealthCare)
• New River Service Authority (New River Behavioral HealthCare)
• Ashley Michelle Nichols, LCAS
• NMG Affiliate Practice I, LLC (Novant Health Oncology Specialists)
• Mary J Noland, LPN; PTA
• North Carolina CVS Pharmacy LLC (CVS Pharmacy #07317)
• Northland Hearing Centers, Inc. (Best Value Hearing Care Center)
• Novant Health Medical Group, LLC (Novant Health Orthopedics & Sports Medicine)

• Medical Physician Assistant in North Wilkesboro, NC
• Providers in North Wilkesboro, NC by specialty
• Medical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2017; 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.