Physician Compare National (NPI:1619251626)

HEALTHCARE PROVIDER: KIMBERLY C NICHOLS NP

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1619251626
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0749447753
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120202000585
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NICHOLS
	Individual professional last name
Provider First Name	KIMBERLY
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	WELLMONT MEDICAL ASSOCIATES INC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	8123291739
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	353
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2202 N JOHN B DENNIS HWY
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	KINGSPORT
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	376605904
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	440012
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WELLMONT BRISTOL REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	490114
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	WELLMONT LONESOME PINE HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	440017
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	WELLMONT HOLSTON VALLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y