Kenneth R Nichols, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C-11080 Issued in NM

Practice address

1001 W Broadway Ste D
Farmington, NM 87401-5638

Phone

(505) 325-0238

NPI assigned

Jan 26, 2017

Last updated

Aug 31, 2020By 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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Presbyterian Medical Services

  dba Rio Rancho Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Rio Rancho, NM
  • NPI 1871505032
  Medicare reassignment NPD
• Presbyterian Medical Services

  dba PMS Central Pharmacy

  • Community/Retail Pharmacy
  • Albuquerque, NM
  • NPI 1306654462
  NPD
• Presbyterian Medical Services

  dba PMS-Socorro Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Socorro, NM
  • NPI 1760805303
  NPD

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

{
    "created_epoch": "1485388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1548707649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "819 N WATSON AVE",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874019127",
            "telephone_number": "253-427-0881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 W BROADWAY STE D",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015638",
            "telephone_number": "505-325-0238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "KENNETH",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-26",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "C-11080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649724055",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619475944",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chasitity Beulah Nez
• Dana Nez
• Leighann Nez, CPSW
• Tashina B Nez
• Brittany Kailin Nichols, RDH
• Sue Ann Nichols, RN
• Ena Marie Niemand
• Meghan Nipper, P.A.
• Nkechinyelu Vivian Nnebe, MD
• David Allen Noakes, MD

• Clinical Social Worker in Farmington, NM
• Providers in Farmington, NM by specialty
• Clinical Social Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; 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.

Verify at the official NPI Registry.