1609082486 NPI number — NICOLE DENISE NICKENS MSN, A-GPNP-BC,

NPI Number: 1609082486
Health Care Provider/Practitioner: NICOLE DENISE NICKENS MSN, A-GPNP-BC,

NPI Number : 1609082486 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609082486",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NICKENS",
    "FirstName": "NICOLE",
    "MiddleName": "DENISE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "MSN, A-GPNP-BC,",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "NICKENS",
    "OtherFirstName": "NICOLE",
    "OtherMiddleName": "DENISE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MSN, A-GPNP-BC,",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "12395 MCCRACKEN RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GARFIELD HTS",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "44125-2967",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "216-587-6727",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "12395 MCCRACKEN RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GARFIELD HTS",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "44125-2967",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "216-587-6727",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/16/2007",
    "LastUpdateDate": "03/11/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207RA0401X",
          "TaxonomyName": "Addiction Medicine (Internal Medicine) Physician",
          "LicenseNumber": "CNP020745",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "APRN.CNP.020745",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "RN346914",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}