Active NPI
Ken Nichols, P.A
- Physician Assistant
- Angleton, TX
National Provider Identifier
1447350574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA01042
- Practice address
- 2327 E Mulberry St
Angleton, TX 77515-3804 - Phone
- (979) 848-8070
- NPI assigned
- Sep 25, 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA01042 | TX | Primary |
Addresses
Primary practice location
2327 E Mulberry St
Angleton, TX 77515-3804
Mailing address
5749 San Felipe St
Houston, TX 77057-3101
Phone (713) 972-0800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8N7577 | Other | TX | BLUE CROSS BLUE SHIELD |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA01042 | TX | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brazos Emergency Physicians, PA | 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.
-
- Emergency Medicine Physician
- Houston, TX
- NPI 1205948635
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315353600000",
"number": "1447350574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5749 SAN FELIPE ST",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770573101",
"telephone_number": "713-972-0800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2327 E MULBERRY ST",
"city": "ANGLETON",
"state": "TX",
"postal_code": "775153804",
"telephone_number": "979-848-8070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "KEN",
"credential": "P.A",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-25",
"last_updated": "2011-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA01042",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "8N7577",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Angleton, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.