Provider Demographics
NPI:1033116462
Name:NICHOLS, KATHLEEN P (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:P
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 52650
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-0133
Mailing Address - Country:US
Mailing Address - Phone:888-206-5902
Mailing Address - Fax:480-466-7536
Practice Address - Street 1:6200 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3529
Practice Address - Country:US
Practice Address - Phone:520-226-4444
Practice Address - Fax:520-226-8376
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ20995207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ100946Medicare PIN
AZE49195Medicare UPIN