Provider Demographics
NPI:1871655019
Name:NICHOLS, JEFF SMITH (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:SMITH
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2917
Mailing Address - Country:US
Mailing Address - Phone:785-842-6500
Mailing Address - Fax:785-843-3219
Practice Address - Street 1:1023 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2917
Practice Address - Country:US
Practice Address - Phone:785-842-6500
Practice Address - Fax:785-843-3219
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-171292084P0800X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSDO5371Medicare UPIN
KS058297Medicare ID - Type UnspecifiedMEDICAL DOCTOR