Kevin Nicholson

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

2468331 Issued in MN

Practice address

2152 S Vineyard Ste 131
Mesa, AZ 85210-6882

Phone

(855) 538-9355

Fax

(844) 538-9355

NPI assigned

May 16, 2019

Last updated

May 16, 2019By the provider in NPPES

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ketamine Wellness Centers Minnesota, LLC

  • Anesthesiology Physician
  • Burnsville, MN
  • NPI 1689234882

  Registered Nurse

  NPD (past)

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

{
    "created_epoch": "1557964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557964800000",
    "number": "1538725353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 W HOOVER AVE STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852105214",
            "telephone_number": "855-538-9355",
            "fax_number": "844-538-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2152 S VINEYARD STE 131",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106882",
            "telephone_number": "855-538-9355",
            "fax_number": "844-538-9355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3130 N Swan Rd",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857121227",
            "country_code": "US",
            "telephone_number": "855-538-9355 x408",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7261 S Broadway Ste 10L",
            "address_purpose": "LOCATION",
            "city": "Littleton",
            "state": "CO",
            "postal_code": "801228017",
            "country_code": "US",
            "telephone_number": "855-538-9355 x408",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "34709 9th Ave S Ste B200",
            "address_purpose": "LOCATION",
            "city": "Federal Way",
            "state": "WA",
            "postal_code": "980038724",
            "country_code": "US",
            "telephone_number": "855-538-9355 x408",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11995 County Road 11 Ste 220",
            "address_purpose": "LOCATION",
            "city": "Burnsville",
            "state": "MN",
            "postal_code": "553375102",
            "country_code": "US",
            "telephone_number": "855-538-9355 x408",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "KEVIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-16",
        "last_updated": "2019-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "2468331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Toni Nicastro, DO
• Alexander Nicholls
• Amanda Evans Nichols
• Gary Nichols
• Analise Nicholson
• Dionne Nick
• Jamee Noelle Nicoletti, PH.D.
• Don K Nicolson, M.D.
• Nicosia Consulting LLC
• David Eugene Nielsen, M.D.

• Registered Nurse in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Registered Nurse in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.

Verify at the official NPI Registry.