Nichoelle Renee Wall, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA156832 Issued in OR

Practice address

5304 N Road 68
Pasco, WA 99301-8078

Phone

(509) 543-9300

Fax

(509) 542-3059

NPI assigned

Nov 4, 2008

Last updated

Apr 15, 2019By 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

Other names 1

• Mrs. Nichoelle Renee Gourley Professional name

Medicare fee-for-service enrollment

Enrolled in WA

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

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lourdes Hospital LLC

  • Internal Medicine Physician
  • Pasco, WA
  • NPI 1659861060
  Medicare reassignment NPD
• Pacific Radiology, Inc. PS

  • Diagnostic Radiology Physician
  • Pasco, WA
  • NPI 1528318722
  NPD
• Our Lady of Lourdes Hospital at Pasco

  dba Lourdes Urgent Care Radiology

  • Diagnostic Radiology Physician
  • Pasco, WA
  • NPI 1639503774
  NPD (past)

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

{
    "created_epoch": "1225756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555286400000",
    "number": "1407009418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "589 NW 11TH ST",
            "city": "HERMISTON",
            "state": "OR",
            "postal_code": "978386600",
            "telephone_number": "541-567-1717",
            "fax_number": "541-564-5994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5304 N ROAD 68",
            "city": "PASCO",
            "state": "WA",
            "postal_code": "993018078",
            "telephone_number": "509-543-9300",
            "fax_number": "509-542-3059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "NICHOELLE",
        "middle_name": "RENEE",
        "name_prefix": "Miss",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-04",
        "last_updated": "2019-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA156832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICHOELLE",
            "last_name": "GOURLEY",
            "middle_name": "RENEE",
            "prefix": "MRS.",
            "credential": "PA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Heather Wadsworth, SLP
• Wal-Mart Stores, Inc (Vision Center 30-3380)
• Walgreen Co (Walgreens #01078)
• Walgreen Co (Walgreens #09765)
• David Campbell Walker, DMD
• Walmart Inc. (Walmart Pharmacy 10-3380)
• Venice Walsh
• Nycol Walters, LAT, ATC
• Cheryl Dale Warren
• Washington Monitoring

• Physician Assistant in Pasco, WA
• Providers in Pasco, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2019; 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.