Larry C Nickens, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

27762 Issued in NC

Practice address

2706 Medical Office Place
Goldsboro, NC 27534-9460

Phone

(919) 734-4736

Fax

(919) 580-1017

NPI assigned

Nov 16, 2006

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

Credentials

Doctor of Medicine

Practice roles

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

• Goldsboro Pediatrics PA

  • Pediatrics Physician
  • Goldsboro, NC
  • NPI 1427125269
  NPD (past)
• Goldsboro Pediatrics PA

  • Rural Health Clinic/Center
  • Princeton, NC
  • NPI 1437927662

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308009600000",
    "number": "1619040532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2706 MEDICAL OFFICE PLACE",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275349460",
            "telephone_number": "919-734-4736",
            "fax_number": "919-580-1017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2706 MEDICAL OFFICE PLACE",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275349460",
            "telephone_number": "919-734-4736",
            "fax_number": "919-580-1017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKENS",
        "first_name": "LARRY",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2011-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "27762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "62640",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "28723",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rosalyn Nicol Newton, PSY.D.
• Christopher Scott Newtown, PA-C
• Gregory S Nichols, DO
• Kimberly Shanetta Nicholson, LCSW-A
• Nick Columbus Company Inc
• Nicole Bauer Counseling PLLC
• Nicole Williams D.D.S., P.a.
• Amy Marie Nolte, COTA
• Ellen Diane Nordgren, DDS
• Brittaney Nores, DPT

• Pediatrics Physician in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2011; 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.