Nathan Vicknair, STUDENT

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

352219 Issued in LA

Practice address

400 W 16TH St
Pueblo, CO 81003-2745

Phone

(719) 584-4000

NPI assigned

Mar 27, 2020

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1585267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785974400000",
    "number": "1376171298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 W 10TH AVE STE 202",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993366304",
            "telephone_number": "509-221-5510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W 16TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032745",
            "telephone_number": "719-584-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKNAIR",
        "first_name": "NATHAN",
        "name_prefix": "Dr.",
        "credential": "STUDENT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-27",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "LA",
            "license": "352219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Gerard Vialpando, M.D.
• John Ryan Vialpando, BS
• Melissa M Vialpando, COTA
• Serenity Lynn Vialpando
• Stephen Vialpando, M.D.
• Vicky J. Lowrance, D.C.
• Dylan None Viebrantz-Zavatini
• Andrea Vigil
• Anthony Vigil
• Bella J. Vigil, BA, CACIII

• Gastroenterology Physician in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Gastroenterology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2026; 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.