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NPI Code Detail

MEDICARE: KYRA NICHOLS

MEDICARE: KYRA NICHOLS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2893ND

General Provider Information

NPI Number : 1205769684
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYRA NICHOLS
Provider Business Mailing Address
First Line : 3155 49TH ST S APT 313
Second Line :
City : FARGO
State : ND
Zip : 58104-4536
Country : US
Telephone Number : 507-259-2548
Fax Number :
Provider Business Practice Location Address
First Line : 5225 23RD AVE S
Second Line :
City : FARGO
State : ND
Zip : 58104-7927
Country : US
Telephone Number : 701-417-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2026
Last Update Date : 06/05/2026

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Directions to “ KYRA NICHOLS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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