Dr. Jourdan Nicholls, DPM, Inc.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

PO 549 Issued in WA

Legal business name

DR. JOURDAN NICHOLLS, DPM, INC.

Practice address

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

Phone

(509) 582-2057

Fax

(509) 374-4945

NPI assigned

Jul 14, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Jourdan Clive Nicholls, DPM

Title

Physician

Phone

(509) 582-2057

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1279065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279065600000",
    "number": "1609188093",
    "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": {
        "organization_name": "DR. JOURDAN NICHOLLS, DPM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-14",
        "last_updated": "2010-07-14",
        "status": "A",
        "authorized_official_last_name": "NICHOLLS",
        "authorized_official_first_name": "JOURDAN",
        "authorized_official_middle_name": "CLIVE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "509-582-2057",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "WA",
            "license": "PO 549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1101377",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Podiatrist in Kennewick, WA
• Providers in Kennewick, WA by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2010; 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.