Jacquelyn Marie Nickele

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

9476 Issued in KY

Practice address

1815 Bardstown Rd
Louisville, KY 40205-1433

Phone

(502) 459-4120

NPI assigned

Apr 28, 2014

Last updated

May 31, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Dr. Ryan & Associates, P.S.C.

  dba DentalWorks

  • General Practice Dentistry
  • Louisville, KY
  • NPI 1104896604
  NPD (past)

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

{
    "created_epoch": "1398643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496188800000",
    "number": "1922418169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860036",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860036",
            "telephone_number": "502-459-4120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 BARDSTOWN RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402051433",
            "telephone_number": "502-459-4120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKELE",
        "first_name": "JACQUELYN",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-28",
        "last_updated": "2017-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "9476",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IN",
            "license": "12012676A",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "KY",
            "license": "9476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine M Nicholson, LSW
• Elizabeth Nicholson, MS CCC/SLP
• Ellen Nicholson, PTA
• Jonisha Nicholson, LPCC
• Shana Fishman Nicholson, RN
• Dana Lynnette Nickell, ARNP
• Bailey L Nickerson, RBT
• Emily Nicklies, PT, DPT
• Michael Carl Nicoson, M.D.
• Vinay Gopal Nidadavolu, M.D

• Orthodontics and Dentofacial Orthopedics Dentistry in Louisville, KY
• Providers in Louisville, KY by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.