Teresann Nickle, FNP-BC, PMHNP-BC, DN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

71012379A Issued in IN

Practice address

4723 W. Main St.
Ste H
Guadalupe, CA 93434

Phone

(805) 343-5577

Fax

(805) 249-0091

NPI assigned

Jan 25, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, IN2 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

Specialty

Nurse Practitioner

Education

University of Alabama School of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Community Physicians of Indiana IncGroup PAC ID 1759416662, 1,569 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tnickle518793@ecommunitydirect.com

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.

• Community Physicians of Indiana Inc

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1619105244

  IN, Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • Oceano, CA
  • NPI 1336166248

  CA, Multi-Specialty

  Medicare reassignment NPD
• Community Health Network, Inc

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1336119478

  IN, Multi-Specialty

  Medicare reassignment NPD
• Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • San Luis Obispo, CA
  • NPI 1275553257

  Multi-Specialty

  NPD
• Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • Santa Maria, CA
  • NPI 1447277355

  Multi-Specialty

  NPD
• Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • Cambria, CA
  • NPI 1881611705
  NPD
• Community Health Centers of the Central Coast, Inc

  • Community Health Clinic/Center
  • San Luis Obispo, CA
  • NPI 1629377452
  NPD
• Community Health Network, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Indianapolis, IN
  • NPI 1265477632
  NPD
• Community Physicians of Indiana Inc

  • Endocrinology, Diabetes & Metabolism Physician
  • Carmel, IN
  • NPI 1992396337
  NPD
• Take Care Health Services PA

  • Family Nurse Practitioner
  • Orlando, FL
  • NPI 1689865818

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647388800000",
    "number": "1831245786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5831 S HARBISON AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462399658",
            "telephone_number": "505-506-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4723 W. MAIN ST.",
            "address_2": "STE H",
            "city": "GUADALUPE",
            "state": "CA",
            "postal_code": "93434",
            "telephone_number": "805-343-5577",
            "fax_number": "805-249-0091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKLE",
        "first_name": "TERESANN",
        "name_prefix": "Dr.",
        "credential": "FNP-BC, PMHNP-BC, DN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "RN501703",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "501703",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "501703",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71012379A",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "RN501703",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Lopez-Montoya
• Stephanie Raquel Macias
• Archana Mallela
• Elizabeth Vega Martinez
• Yecenia Muniz
• Sabrina Ornelas
• Christine Joohee Park, M.D.
• Jose C Pesqueda, PA-C
• Mireya Eulalia Pina
• Christina Anne Pinto, D.O.

• Psychiatric/Mental Health Nurse Practitioner in Guadalupe, CA
• Providers in Guadalupe, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.