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NPI Code Detail

MEDICARE: DR. WILLIAM PATRICK NICHOLS M.D.

MEDICARE: DR. WILLIAM PATRICK NICHOLS M.D.
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
1207RC0000XCardiovascular Disease Physician25101MS
2207RI0011XInterventional Cardiology Physician25101MS

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
21Q4772OTHERMSMEDICARE ST DOM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
325101OTHERMSMS MED LIC
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306258330
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM PATRICK NICHOLS M.D.
Provider Business Mailing Address
First Line : 970 LAKELAND DR STE 61
Second Line :
City : JACKSON
State : MS
Zip : 39216-4682
Country : US
Telephone Number : 601-982-7850
Fax Number :
Provider Business Practice Location Address
First Line : 970 LAKELAND DR STE 61
Second Line :
City : JACKSON
State : MS
Zip : 39216-4682
Country : US
Telephone Number : 601-982-7850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2014
Last Update Date : 11/15/2023

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