Healthcare Provider Details

I. General information

NPI: 1962210005
Provider Name (Legal Business Name): NICOLE MARIE FIRESTONE APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S MAIN ST
OTTAWA KS
66067-3315
US

IV. Provider business mailing address

901 S MAIN ST
OTTAWA KS
66067-3315
US

V. Phone/Fax

Practice location:
  • Phone: 785-521-6300
  • Fax: 785-521-6301
Mailing address:
  • Phone: 785-521-6300
  • Fax: 785-521-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-83945-071
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number13-115764-071
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: