Individual provider Active NPI

Nicholas Michael Nelson, PHARMD, BCPS, BCGP

  • Geriatric Pharmacist
  • Wichita, KS
National Provider Identifier
1962716357
Registry record updated Dec 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric PharmacistTaxonomy code 1835G0303X
License
21203 Issued in NC
Practice address
5500 E Kellogg Dr
Wichita, KS 67218-1607
Phone
(316) 685-2221
Fax
(316) 634-3048
NPI assigned
Jul 28, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacotherapy Pharmacist 1835P1200X 14855-1 KS
Geriatric Pharmacist 1835G0303X 21203 NC Primary

Addresses

Primary practice location

5500 E Kellogg Dr
Wichita, KS 67218-1607

Mailing address

5500 E Kellogg Dr
Wichita, KS 67218-1607
Phone (316) 685-2221

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
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
21203NCMDGeriatric Pharmacist
14855-1KSMDPharmacotherapy Pharmacist

NPI Registry JSON

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

{
    "created_epoch": "1280275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606780800000",
    "number": "1962716357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 E KELLOGG DR",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672181607",
            "telephone_number": "316-685-2221",
            "fax_number": "316-634-3048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 E KELLOGG DR",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672181607",
            "telephone_number": "316-685-2221",
            "fax_number": "316-634-3048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "NICHOLAS",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "PHARMD, BCPS, BCGP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-28",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P1200X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacotherapy",
            "state": "KS",
            "license": "14855-1",
            "primary": false
        },
        {
            "code": "1835G0303X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Geriatric",
            "state": "NC",
            "license": "21203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.