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NPI Code Detail

MEDICARE: NICHOLAS DAVID IMMEL

MEDICARE: NICHOLAS DAVID IMMEL
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
1390200000XStudent in an Organized Health Care Education/Training ProgramMO

General Provider Information

NPI Number : 1629914544
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS DAVID IMMEL
Provider Business Mailing Address
First Line : 800 W JEFFERSON ST
Second Line :
City : KIRKSVILLE
State : MO
Zip : 63501-1443
Country : US
Telephone Number : 866-626-2878
Fax Number :
Provider Business Practice Location Address
First Line : 800 W JEFFERSON ST
Second Line :
City : KIRKSVILLE
State : MO
Zip : 63501-1443
Country : US
Telephone Number : 866-626-2878
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2026
Last Update Date : 04/24/2026

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Directions to “ NICHOLAS DAVID IMMEL ” Practice Location

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