Kimberly A Nicholson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME102851 Issued in FL

Practice address

9350 Camelot Dr
Fort Myers, FL 33919-7980

Phone

(239) 481-5437

Fax

(239) 481-0571

NPI assigned

Jan 10, 2007

Sex

Female

Sole proprietor

Yes

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

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kimberly.nicholson@ppcswfl.eclinicaldirectplus.com

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.

• Physicians Primary Care of Southwest Florida PL

  • General Practice Physician
  • Fort Myers, FL
  • NPI 1356336705

  Pediatrics

  Medicare reassignment NPD
• Physicians Primary Care of Southwest Florida PL

  • Pediatrics Physician
  • Cape Coral, FL
  • NPI 1326021239
  NPD
• Emergency Physicians of Naples PLLC

  • Emergency Medicine Physician
  • Naples, FL
  • NPI 1861410656
  NPD (past)
• Epn Family Care LLC

  • Family Medicine Physician
  • Naples, FL
  • NPI 1013101112
  NPD (past)
• Epn Urgent Care LLC

  • Emergency Medicine Physician
  • Naples, FL
  • NPI 1275624579
  NPD (past)
• Southwest Florida Emergency Management LLC

  • Emergency Medicine Physician
  • Naples, FL
  • NPI 1780911206
  NPD (past)

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597968000000",
    "number": "1629127188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12730 NEW BRITTANY BLVD STE 602",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339074690",
            "telephone_number": "239-275-5522",
            "fax_number": "239-275-4464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9350 CAMELOT DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339197980",
            "telephone_number": "239-481-5437",
            "fax_number": "239-481-0571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-10",
        "last_updated": "2020-08-21",
        "certification_date": "2020-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME102851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FLORIDA",
            "identifier": "93132",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000607900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Lee Nichols
• Lydia Patrice Nichols, LPN
• Tyler Jackson Nichols
• Cameron Lee Nicholson, M.D.
• Kaitlin Elaine Nicholson, ATC
• Antonio Nickel, PA-C
• Ryan Nickens, D.C.
• Diane Nicolette
• Tricia Lynne Nicolette, MS, CCC-SLP
• Debra E. Nicolosi

• Pediatrics Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.