Active NPI
Kendra Nicol
- Physical Medicine & Rehabilitation Physician
- Grand Rapids, OH
National Provider Identifier
1801503305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- PTA013421
- Practice address
- 24201 W. 3Rd Street
Grand Rapids, OH 43522 - Phone
- (419) 832-5195
- NPI assigned
- Nov 3, 2022
- 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 Medicine & Rehabilitation Physician | 208100000X | PTA013421 | OH | Primary |
Addresses
Primary practice location
24201 W. 3Rd Street
Grand Rapids, OH 43522
Mailing address
182 North Seffner Avenue
Marion, OH 43302
Phone (937) 668-4654
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 |
|---|---|---|---|
| PTA013421 | OH | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667433600000",
"number": "1801503305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "182 NORTH SEFFNER AVENUE",
"city": "MARION",
"state": "OH",
"postal_code": "43302",
"telephone_number": "937-668-4654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24201 W. 3RD STREET",
"city": "GRAND RAPIDS",
"state": "OH",
"postal_code": "43522",
"telephone_number": "419-832-5195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOL",
"first_name": "KENDRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-11-03",
"last_updated": "2022-11-03",
"certification_date": "2022-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "OH",
"license": "PTA013421",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 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.