Kimberly Nichelson DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

KIMBERLY NICHELSON DPM

Practice address

630 E River St
Elyria, OH 44035-5902

Phone

(419) 750-0041

NPI assigned

Sep 6, 2022

Last updated

Sep 6, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kimberly M Nichelson, DPMNPI 1538504360

Title

Ceo

Phone

(419) 750-0041

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kimberly Marie Nichelson, DPM

  • Foot & Ankle Surgery Podiatrist
  • Sheffield Village, OH
  • NPI 1538504360
  NPD (past) Authorized official

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

{
    "created_epoch": "1662422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662422400000",
    "number": "1568183846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 TRAILHEAD LN",
            "city": "BEREA",
            "state": "OH",
            "postal_code": "440171099",
            "telephone_number": "419-750-0041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 E RIVER ST",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440355902",
            "telephone_number": "419-750-0041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBERLY NICHELSON DPM",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-06",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A",
        "authorized_official_last_name": "NICHELSON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-750-0041",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "36.003767",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ekaterina Kholyavka, NP-C
• Deloris Kibble
• McKenzie Kidd
• Shana Kieswetter, RN
• Jerome Francis Kiffer
• Delcenia Kimbrough, CARE COORDINATOR
• Amy M. King, NP
• Jennifer King, CDCA
• Marie Grace King, CRNA
• Melissa King

• Foot & Ankle Surgery Podiatrist in Elyria, OH
• Providers in Elyria, OH by specialty
• Foot & Ankle Surgery Podiatrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; 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.