Active NPI
Derek Nichols
- Athletic Trainer
- Alamosa, CO
National Provider Identifier
1760841621
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2000018480
- Practice address
- 117 Poncha Ave
Alamosa, CO 81101-2166 - Phone
- (503) 779-9322
- NPI assigned
- Feb 19, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2000018480 | OR | Primary |
Addresses
Primary practice location
117 Poncha Ave
Alamosa, CO 81101-2166
Mailing address
117 Poncha Ave
Alamosa, CO 81101
Phone (503) 779-9322
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 |
|---|---|---|---|
| 2000018480 | OR | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455840000000",
"number": "1760841621",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 PONCHA AVE",
"city": "ALAMOSA",
"state": "CO",
"postal_code": "81101",
"telephone_number": "503-779-9322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 PONCHA AVE",
"city": "ALAMOSA",
"state": "CO",
"postal_code": "811012166",
"telephone_number": "503-779-9322"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "DEREK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-02-19",
"last_updated": "2016-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OR",
"license": "2000018480",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alamosa, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.