Nicholas R Fredricks

Primary specialty

Child & Adolescent Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0807X

License

47072 Issued in WY

Practice address

555 E Broadway Ave Ste 218
Jackson, WY 83001-8640

Phone

(307) 739-4818

NPI assigned

Aug 27, 2024

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1724716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1447084959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7005",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830027005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E BROADWAY AVE STE 218",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018640",
            "telephone_number": "307-739-4818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDRICKS",
        "first_name": "NICHOLAS",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-27",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0807X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "WY",
            "license": "47072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Pringle Ford, MSW
• Four Pines Physical Therapy Limited Partnership
• Four Pines Physical Therapy PC
• Heather Noelle Franklin, PCSW
• Hannah Lane Fredricks, LCSW
• O'Ann Karin Fredstrom, MD
• Kurt Freischlag, OT
• /Cynthia Ann French, CRNA
• Steven Pirtle French, M.D.
• Jennifer J Fritch, PA

• Child & Adolescent Psychiatric/Mental Health Registered Nurse in Jackson, WY
• Providers in Jackson, WY by specialty
• Child & Adolescent Psychiatric/Mental Health Registered Nurse in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; 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.