Jourdan Clive Nicholls, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

PO549 Issued in WA

Practice address

7103 W Grandridge Blvd
Suite F
Kennewick, WA 99336-6713

Phone

(509) 582-2057

Fax

(509) 374-4945

NPI assigned

Feb 1, 2007

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375142400000",
    "number": "1578601720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7103 W GRANDRIDGE BLVD",
            "address_2": "SUITE F",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993366713",
            "telephone_number": "509-582-2057",
            "fax_number": "509-374-4945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7103 W GRANDRIDGE BLVD",
            "address_2": "SUITE F",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993366713",
            "telephone_number": "509-582-2057",
            "fax_number": "509-374-4945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLLS",
        "first_name": "JOURDAN",
        "middle_name": "CLIVE",
        "name_prefix": "Mr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2013-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "WA",
            "license": "PO549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUST",
            "identifier": "89978401",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1101377",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natalie Maxine Newton
• Peris Ngethe
• Lan Thi Ngoc Nguyen, DMD
• Nhan Phuoc Nguyen, PHARMD.
• Thu Ha Nguyen, MD
• Bonnie Lee Nickerson, LPN
• Nickolas Allen DC
• Chloe Anne Nidick
• Alexis Nieffenegger, RN
• Heidi Nielson

• Podiatrist in Kennewick, WA
• Providers in Kennewick, WA by specialty
• Podiatrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2013; 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.