Active NPI
Wendell Allan Nickerson, D.O.
- Family Medicine Physician
- Shelbina, MO
National Provider Identifier
1437249588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R9E45
- Practice address
- 400 S Center St
Shelbina, MO 63468-1404 - Phone
- (573) 588-4131
- Fax
- (573) 588-6602
- NPI assigned
- Oct 12, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R9E45 | MO | Primary |
Addresses
Primary practice location
400 S Center St
Shelbina, MO 63468-1404
Mailing address
400 S Center St
Shelbina, MO 63468-1404
Phone (573) 588-4131
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 509038808 | Medicaid | MO |
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)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R9E45 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozarks Medical Center | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Ozarks Healthcare
- General Acute Care Hospital
- West Plains, MO
- NPI 1831115641
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547510400000",
"number": "1437249588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 S CENTER ST",
"city": "SHELBINA",
"state": "MO",
"postal_code": "634681404",
"telephone_number": "573-588-4131",
"fax_number": "573-588-4876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 S CENTER ST",
"city": "SHELBINA",
"state": "MO",
"postal_code": "634681404",
"telephone_number": "573-588-4131",
"fax_number": "573-588-6602"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKERSON",
"first_name": "WENDELL",
"middle_name": "ALLAN",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2019-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "R9E45",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "509038808",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shelbina, MO
- Hannibal Regional Healthcare System, Inc (Shelbina Family Practice)
- Adrienne Harvey, SLP-A
- Johnston Drug - Shelbina
- Lou Ann McEwen
- Moberly Medical Clinics Inc
- David F. Ouellette, M.D.
- Barbara B Russell, DDS
- Wesley A Russell II, DDS
- Kelly M Sadler, PT, DPT
- Salt River Nursing Home District (Salt River Community Care)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.