Kelly Nicole Nickerson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT026486 Issued in PA

Practice address

625 Walnut St
McKeesport, PA 15132-2806

Phone

(412) 673-5005

NPI assigned

Nov 15, 2017

Last updated

Mar 24, 2021By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1510704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1376056119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 WALNUT ST",
            "city": "MCKEESPORT",
            "state": "PA",
            "postal_code": "151322806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 WALNUT ST",
            "city": "MCKEESPORT",
            "state": "PA",
            "postal_code": "151322806",
            "telephone_number": "412-673-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "KELLY",
        "middle_name": "NICOLE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-15",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT026486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "UPMChospitals@upmcdirect.com",
            "affiliation": "N",
            "endpointDescription": "Secure UPMC Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "625 Walnut St",
            "city": "McKeesport",
            "state": "PA",
            "country_code": "US",
            "postal_code": "151322806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Carleen Susan Neher, OTR/L
• Juanita A Neill, MACC,LPC
• Anthony Trelane Nelson, MA, NCC
• Esther Mwiyeria Ngare, MD
• Khoi Nguyen, M.D.
• Kweilin Nickles
• Kelly Niecgorski, OTR
• Brittany Niro
• Katrina Nola, LPC
• Norman L. Edelstein, M.D., P.C.

• Physical Therapist in McKeesport, PA
• Providers in McKeesport, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; 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.