Alexander Ely Nicholson, NPP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

F401487-1 Issued in NY

Practice address

711 Troy Schenectady Rd Ste 202
Latham, NY 12110-2461

Phone

(518) 782-3703

Fax

(518) 782-3809

NPI assigned

Jul 8, 2012

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2016 through Apr 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1341705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1669737466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD STE 202",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102461",
            "telephone_number": "518-782-3703",
            "fax_number": "518-782-3809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD STE 202",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102461",
            "telephone_number": "518-782-3703",
            "fax_number": "518-782-3809"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 West Ave Ste 205",
            "address_purpose": "LOCATION",
            "city": "Saratoga Springs",
            "state": "NY",
            "postal_code": "128666064",
            "country_code": "US",
            "telephone_number": "518-587-0499",
            "fax_number": "518-587-0536",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 Executive Park Dr",
            "address_2": "suite 16",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122033700",
            "country_code": "US",
            "telephone_number": "518-438-0033",
            "fax_number": "518-438-0055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "ALEXANDER",
        "middle_name": "ELY",
        "name_prefix": "Mr.",
        "credential": "NPP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-08",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F401487-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jessica Nicole Nicklo, FNP
• Nicol's Village Vibes, LLC
• Nicolla and Associates, PT & OT Services, PLLC
• Thomas Christopher Nicolla Jr., PT

• Psychiatric/Mental Health Nurse Practitioner in Latham, NY
• Providers in Latham, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.