Active NPI
Kourtney Nickelson, P.T.A.
- Physical Therapy Assistant
- Carmel, IN
National Provider Identifier
1780123653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 06005451A
- Practice address
- 118 Medical Dr
Carmel, IN 46032-2923 - Phone
- (317) 573-1037
- NPI assigned
- Feb 13, 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 | 06005451A | IN | Primary |
Addresses
Primary practice location
118 Medical Dr
Carmel, IN 46032-2923
Mailing address
4746 E Highway 36
Mooreland, IN 47360
Phone (765) 571-2501
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 |
|---|---|---|---|
| 06005451A | IN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486944000000",
"number": "1780123653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4746 E HIGHWAY 36",
"city": "MOORELAND",
"state": "IN",
"postal_code": "47360",
"telephone_number": "765-571-2501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 MEDICAL DR",
"city": "CARMEL",
"state": "IN",
"postal_code": "460322923",
"telephone_number": "317-573-1037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKELSON",
"first_name": "KOURTNEY",
"credential": "P.T.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-13",
"last_updated": "2017-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IN",
"license": "06005451A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carmel, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.