Active NPI
Amanda Donn Nichols, PTA
- Physical Therapy Assistant
- Grayson, KY
National Provider Identifier
1689109639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A03551
- Practice address
- 361 Windburn LN
Grayson, KY 41143-8372 - Phone
- (606) 316-1171
- NPI assigned
- Apr 27, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A03551 | KY | Primary |
Addresses
Primary practice location
361 Windburn LN
Grayson, KY 41143-8372
Mailing address
951 State Route 784
South Shore, KY 41175-9791
Phone (606) 694-0396
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A03551 | KY | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493251200000",
"number": "1689109639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "951 STATE ROUTE 784",
"city": "SOUTH SHORE",
"state": "KY",
"postal_code": "411759791",
"telephone_number": "606-694-0396"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "361 WINDBURN LN",
"city": "GRAYSON",
"state": "KY",
"postal_code": "411438372",
"telephone_number": "606-316-1171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "AMANDA",
"middle_name": "DONN",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-27",
"last_updated": "2017-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "KY",
"license": "A03551",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grayson, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.