Healthcare Provider Details

I. General information

NPI: 1619088879
Provider Name (Legal Business Name): RAMON L NICHOLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N 4TH ST
LEAVENWORTH KS
66048-1572
US

IV. Provider business mailing address

2741 NE MCBAINE DR
LEES SUMMIT MO
64064-7880
US

V. Phone/Fax

Practice location:
  • Phone: 913-297-9945
  • Fax:
Mailing address:
  • Phone: 913-345-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number04-26935
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number04-29635
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR5D43
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberR5D43
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: