Active NPI
Kimberly McClure Nichols I, B.S.
- Pharmacist
- Ponte Vedra Beach, FL
National Provider Identifier
1346360252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 16197
- Practice address
- 290 Solana Rd
Ponte Vedra Beach, FL 32082-2234 - Phone
- (904) 543-8678
- NPI assigned
- Apr 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 16197 | FL | Primary |
Addresses
Primary practice location
290 Solana Rd
Ponte Vedra Beach, FL 32082-2234
Mailing address
227 Davis St
Neptune Beach, FL 32266-4928
Phone (904) 241-8239
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PH0018892 | Other | DC | PHARMACY LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16197 | FL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1346360252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "227 DAVIS ST",
"city": "NEPTUNE BEACH",
"state": "FL",
"postal_code": "322664928",
"telephone_number": "904-241-8239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "290 SOLANA RD",
"city": "PONTE VEDRA BEACH",
"state": "FL",
"postal_code": "320822234",
"telephone_number": "904-543-8678"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "KIMBERLY",
"middle_name": "MCCLURE",
"name_prefix": "Mrs.",
"name_suffix": "I",
"credential": "B.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-02",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "16197",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACY LICENSE",
"identifier": "PH0018892",
"state": "DC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ponte Vedra Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.