MEDICARE: DR. LLOYD EMERY NICKERSON M.D.

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	207Q00000X	Family Medicine Physician	38151	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0138R	OTHER	NC	BLUECROSS GROUP ID
2	28472	OTHER	NC	MAMSI ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	01-41632	OTHER	NC	UNITED HEALTHCARE
5	202595	OTHER	NC	BLACK LUNG ID
6	62644	OTHER	NC	BCBS PERSONAL ID
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	38151	OTHER	NC	STATE LICENSE
9	561794820	OTHER	NC	PRUDENTIAL ID
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	3926	OTHER	NC	PARTNERS ID
12	2723	OTHER	NC	HEALTHSOURCE
13	561794820	OTHER	NC	AETNA US HEALTHCARE
14	561794820	OTHER	NC	CIGNA ID #

General Provider Information

NPI Number	:	1942382940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LLOYD EMERY NICKERSON M.D.

Provider Business Mailing Address
First Line	:	1811 E INNES ST
Second Line	:
City	:	SALISBURY
State	:	NC
Zip	:	28146-6030
Country	:	US
Telephone Number	:	704-216-8777
Fax Number	:	704-638-3129

Provider Business Practice Location Address
First Line	:	1811 E INNES ST
Second Line	:
City	:	SALISBURY
State	:	NC
Zip	:	28146-6030
Country	:	US
Telephone Number	:	704-216-8777
Fax Number	:	704-638-3129

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	03/07/2023

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