Active NPI
Kristen Benae Nichols, D.D.S.
- Prosthodontics
- Jbsa Lackland, TX
National Provider Identifier
1467431874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 6544
- Practice address
- 1100 Wilford Hall Loop, BLDG 4554
Attn: 59 MDW/SGHC
Jbsa Lackland, TX 78236-9908 - Phone
- (210) 292-0768
- NPI assigned
- Jan 13, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 6544 | NE | Primary |
Addresses
Primary practice location
1100 Wilford Hall Loop, BLDG 4554
Attn: 59 MDW/SGHC
Jbsa Lackland, TX 78236-9908
Mailing address
1100 Wilford Hall Loop, BLDG 4554
Attn: 59 MDW/SGHC
Jbsa Lackland, TX 78236-9908
Phone (210) 292-0768
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160706001433 | DC | Order and Referring Only - Other (Physician) | 7810289279 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689552000000",
"number": "1467431874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 WILFORD HALL LOOP, BLDG 4554",
"address_2": "ATTN: 59 MDW/SGHC",
"city": "JBSA LACKLAND",
"state": "TX",
"postal_code": "782369908",
"telephone_number": "210-292-0768"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 WILFORD HALL LOOP, BLDG 4554",
"address_2": "ATTN: 59 MDW/SGHC",
"city": "JBSA LACKLAND",
"state": "TX",
"postal_code": "782369908",
"telephone_number": "210-292-0768"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "KRISTEN",
"middle_name": "BENAE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-13",
"last_updated": "2023-07-17",
"certification_date": "2023-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "NE",
"license": "6544",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jbsa Lackland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; 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.