Active NPI
Jerilynn Nichols, MS, PHARMD, CGC
- Pharmacist
- Mexico, MO
National Provider Identifier
1740311786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2015023146
- Practice address
- 4820 S Clark St
Mexico, MO 65265-4111 - Phone
- (573) 239-5715
- NPI assigned
- Mar 9, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Genetic Counselor (M.S.) | 170300000X | |||
| Pharmacist | 183500000X | 2015023146 | MO | Primary |
Addresses
Primary practice location
4820 S Clark St
Mexico, MO 65265-4111
Mailing address
4820 S Clark St
Mexico, MO 65265-4111
Phone (573) 581-2600
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
- Credentials
- Master of Science, Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2015023146 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642636800000",
"number": "1740311786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4820 S CLARK ST",
"city": "MEXICO",
"state": "MO",
"postal_code": "652654111",
"telephone_number": "573-581-2600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4820 S CLARK ST",
"city": "MEXICO",
"state": "MO",
"postal_code": "652654111",
"telephone_number": "573-239-5715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "JERILYNN",
"name_prefix": "Dr.",
"credential": "MS, PHARMD, CGC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-09",
"last_updated": "2022-01-20",
"certification_date": "2022-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "170300000X",
"taxonomy_group": "",
"desc": "Genetic Counselor, MS",
"state": null,
"license": null,
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2015023146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mexico, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.