Active NPI
Cody Don Nickles, PT
- Physical Therapist
- Wynne, AR
National Provider Identifier
1891042396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT4335
- Practice address
- 3027 Hwy 364 East
Wynne, AR 72387 - Phone
- (870) 588-2408
- NPI assigned
- Aug 14, 2012
- Last updated
- Oct 9, 2018
- Sex
- Male
- 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 Therapist | 225100000X | PT4335 | AR | Primary |
Addresses
Primary practice location
3027 Hwy 364 East
Wynne, AR 72387
Mailing address
1011 Marion Dr
Wynne, AR 72396-2428
Phone (870) 588-2408
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 |
|---|---|---|---|
| PT4335 | AR | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crowley's Ridge Therapies, Inc | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539043200000",
"number": "1891042396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1011 MARION DR",
"city": "WYNNE",
"state": "AR",
"postal_code": "723962428",
"telephone_number": "870-588-2408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3027 HWY 364 EAST",
"city": "WYNNE",
"state": "AR",
"postal_code": "72387",
"telephone_number": "870-588-2408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKLES",
"first_name": "CODY",
"middle_name": "DON",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-14",
"last_updated": "2018-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AR",
"license": "PT4335",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wynne, AR
- Madison Naceanceno
- Neall Jackson DDS PA (Puryear Jackson Family Dentistry)
- Rhonda Nelson
- Zachary Grant Nethercutt, CHILD/ ADULT CIS
- Hong-Van Nguyen, MD
- Juliet Noel, RPT
- Michael O. Norris, OD
- Northeast Arkansas Community Mental Health Center (MidSouth Health Systems)
- Northeast Arkansas Community Mental Health Center Inc (MidSouth Health Systems)
- Northeast Arkansas Community Mental Health Center Inc (Mid-South Health Systems)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.