MEDICARE: JUSTIN NICHOLS RN

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
1	163WE0003X	Emergency Registered Nurse	2013025569	MO
2	163WC1500X	Community Health Registered Nurse	2013025569	MO

General Provider Information

NPI Number	:	1427562123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN NICHOLS RN

Provider Business Mailing Address
First Line	:	600 W 39TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2910
Country	:	US
Telephone Number	:	816-421-7608
Fax Number	:	816-421-6493

Provider Business Practice Location Address
First Line	:	600 W 39TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2910
Country	:	US
Telephone Number	:	816-421-7608
Fax Number	:	816-421-6493

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2017
Last Update Date	:	05/18/2023

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