Provider Demographics
NPI:1427562123
Name:NICHOLS, JUSTIN (RN)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2910
Mailing Address - Country:US
Mailing Address - Phone:816-421-7608
Mailing Address - Fax:816-421-6493
Practice Address - Street 1:600 W 39TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2910
Practice Address - Country:US
Practice Address - Phone:816-421-7608
Practice Address - Fax:816-421-6493
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013025569163WE0003X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency