Active NPI
Michael A Nicholas, PHD
- Clinical Neuropsychologist
- Paducah, KY
National Provider Identifier
1467471565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 850
- Practice address
- 100 Fountain Ave
Suite 220
Paducah, KY 42001-2771 - Phone
- (270) 408-4192
- Fax
- (270) 443-1784
- NPI assigned
- Jul 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 850 | KY | Primary |
Addresses
Primary practice location
100 Fountain Ave
Suite 220
Paducah, KY 42001-2771
Mailing address
PO Box 7223
Paducah, KY 42002-7223
Phone (270) 408-4192
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 Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 850 | KY | MD | Clinical Neuropsychologist |
| 71 | KY | MD | Psychologist |
| 0850 | KY | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212624000000",
"number": "1467471565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7223",
"city": "PADUCAH",
"state": "KY",
"postal_code": "420027223",
"telephone_number": "270-408-4192",
"fax_number": "270-443-1784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 FOUNTAIN AVE",
"address_2": "SUITE 220",
"city": "PADUCAH",
"state": "KY",
"postal_code": "420012771",
"telephone_number": "270-408-4192",
"fax_number": "270-443-1784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLAS",
"first_name": "MICHAEL",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-19",
"last_updated": "2008-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "KY",
"license": "850",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Paducah, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.