Healthcare Provider Details

I. General information

NPI: 1407054745
Provider Name (Legal Business Name): KENSLEY NICHOLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2007
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 LANDOVER PL
LYNCHBURG VA
24501-2115
US

IV. Provider business mailing address

2215 LANDOVER PL
LYNCHBURG VA
24501-2115
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-3944
  • Fax: 434-544-2337
Mailing address:
  • Phone: 434-947-3944
  • Fax: 434-544-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number048960
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number48960
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101261116
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: