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1376826925 NPI number — WILLIAM DAVID NICKELL PA-C

NPI Number: 1376826925
Health Care Provider/Practitioner: WILLIAM DAVID NICKELL PA-C

Information about “1376826925” NPI (WILLIAM DAVID NICKELL PA-C) exists in 1376826925 in HTML format HTML  |  1376826925 in plain Text format TXT  |  1376826925 in PDF (Portable Document Format) PDF  |  1376826925 in an XML format XML  formats.

NPI Number : 1376826925 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376826925",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NICKELL",
    "FirstName": "WILLIAM",
    "MiddleName": "DAVID",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "NICKELL",
    "OtherFirstName": "DAVE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PA-C",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "100 MEDICAL CENTER DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SPRINGFIELD",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "45504-2687",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "937-523-9885",
    "MailingAddressFaxNumber": "937-523-9887",
    "FirstLinePracticeLocationAddress": "100 MEDICAL CENTER DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SPRINGFIELD",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "45504-2687",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "937-523-9885",
    "PracticeLocationAddressFaxNumber": "937-523-9887",
    "EnumerationDate": "09/20/2011",
    "LastUpdateDate": "09/24/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "003357",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "003357",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PAC1180",
          "LicenseNumberStateCode": "ND",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AS0400X",
          "TaxonomyName": "Surgical Physician Assistant",
          "LicenseNumber": "003357",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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