Provider Demographics
NPI:1356309710
Name:NICHOLS, KIMBERLEY R (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:R
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-2539
Mailing Address - Country:US
Mailing Address - Phone:919-966-8596
Mailing Address - Fax:919-843-5515
Practice Address - Street 1:101 MANNING DR.
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-966-8596
Practice Address - Fax:919-843-5515
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238564207L00000X, 208VP0000X
NC200401424207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917900Medicaid
VA010214360Medicaid
VA009229B26Medicare PIN
NC21580004Medicare UPIN
NC5917900Medicaid