MEDICARE: KIM NICHOLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1275356511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM NICHOLS

Provider Business Mailing Address
First Line	:	6610 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4392
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5315 LAFAYETTE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-1618
Country	:	US
Telephone Number	:	317-297-9622
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2024
Last Update Date	:	11/05/2024

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Directions to “ KIM NICHOLS ” Practice Location

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