Nicole L Ralston, AGNP-C

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

AP8413 Issued in AZ

Practice address

5301 E Grant Rd
Tucson, AZ 85712-2805

Phone

(520) 324-1205

Fax

(520) 324-3650

NPI assigned

Nov 26, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Nicole Thevenot Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Hospice in the Desert LLC

  • Community Based Hospice Care Agency
  • Tucson, AZ
  • NPI 1255052585
  NPD
• Tucson Medical Center

  • Psychiatric Hospital Unit
  • Tucson, AZ
  • NPI 1881683126
  NPD (past)

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

{
    "created_epoch": "1448496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631750400000",
    "number": "1619341831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31235",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857511235",
            "telephone_number": "520-324-2308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 E GRANT RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857122805",
            "telephone_number": "520-324-1205",
            "fax_number": "520-324-3650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1423 W Kandy Ct",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857453805",
            "country_code": "US",
            "telephone_number": "520-248-8129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RALSTON",
        "first_name": "NICOLE",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "AGNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-26",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AZ",
            "license": "AP8413",
            "primary": false
        },
        {
            "code": "163WH1000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Hospice",
            "state": "MD",
            "license": "RN113296",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "AZ",
            "license": "AP8413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "489037",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "THEVENOT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kevin T Ralls, NP-C
• Ralph a. Lemcke, MD, PC
• Aspen I Ralph, DO
• Leslie Elizabeth Romero Ralph, PH.D.
• Jon Robert Ralston, LAC
• Christopher Amee Ram, D.C.
• Anil Prasad Rama Rao, M.D.
• Ramya Ramachandran
• Sivapriya Ramakrishnan, M.D
• Jagan Ramamoorthy, M.D.

• Adult Health Nurse Practitioner in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Adult Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; 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.