Individual provider Active NPI

Debra Lee Nicholls, ARNP

  • Acute Care Nurse Practitioner
  • Prescott Valley, AZ
National Provider Identifier
1730770579
Registry record updated Feb 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
265112 Issued in AZ
Practice address
7700 E Florentine Rd Ste 206
Prescott Valley, AZ 86314-2245
Phone
(928) 442-8117
Fax
(928) 772-8947
NPI assigned
Feb 2, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X AP61337993 WA
Acute Care Nurse Practitioner 363LA2100X 265112 AZ Primary

Addresses

Primary practice location

7700 E Florentine Rd Ste 206
Prescott Valley, AZ 86314-2245

Mailing address

PO Box 10880
Prescott, AZ 86304-0880
Phone (602) 406-4786

Other identifiers 1

IdentifierTypeStateIssuer
206471MedicaidAZ

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address credentialing@postacute.org Direct
Direct Messaging Address credentialing@postacute.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, AZ2 enrollments
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.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221005003060 WA Practitioner - Nurse Practitioner 1052797677 Reassigns benefits to 2 organizations
I20240730000744 AZ Practitioner - Nurse Practitioner 1052797677 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7700 E Florentine Rd
Suite 206
Prescott Valley, AZ 86314-2245
Phone (928) 442-8117

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP61337993WAMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Yavapai Regional Medical Center Physician Care LLC CurrentSince Sep 1, 2024 Accepting new patients
Cardiorenal Therapeutics of Washington, PLLC CurrentSince Feb 3, 2023 Accepting new patients
Yavapai Regional Medical Center Physician Care LLC CurrentSince Sep 1, 2024 Accepting new patients
Yavapai Regional Medical Center Physician Care LLC Current Accepting new patients
Post Acute Medical PLLC CurrentSince Sep 16, 2022 Accepting new patients
Prescott Gastroenterology Past Accepting new patients

Locations

400 E Rivulon Blvd
Ste 103
Gilbert, AZ 85297

3120 Clearwater Dr
Prescott, AZ 86305
Phone (928) 445-4818

7700 E Florentine Rd
Ste 206
Prescott Valley, AZ 86314
Phone (928) 442-8117

33530 1st Way S
Ste 44
Federal Way, WA 98003
Phone (253) 300-8447

6220 S Alaska St
Tacoma, WA 98408
Phone (253) 473-2273

Organizations & group practices 6

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739750400000",
    "number": "1730770579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10880",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040880",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7700 E FLORENTINE RD STE 206",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142245",
            "telephone_number": "928-442-8117",
            "fax_number": "928-772-8947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLLS",
        "first_name": "DEBRA",
        "middle_name": "LEE",
        "name_prefix": "Ms.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-02",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "WA",
            "license": "AP61337993",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AZ",
            "license": "265112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206471",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "credentialing@postacute.org",
            "affiliation": "N",
            "endpointDescription": "work affiliation",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "direct",
            "address_1": "1554 Pennsylvania Ave",
            "city": "Bremerton",
            "state": "WA",
            "country_code": "US",
            "postal_code": "983371145",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "credentialing@postacute.org",
            "affiliation": "N",
            "endpointDescription": "work affiliation",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "direct",
            "address_1": "1554 Pennsylvania Ave",
            "city": "Bremerton",
            "state": "WA",
            "country_code": "US",
            "postal_code": "983371145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Prescott Valley, AZ

Sources for this page

Verify at the official NPI Registry.