MEDICARE: NICHOLAS SOULE

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	175T00000X	Peer Specialist		OR

General Provider Information

NPI Number	:	1568326346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS SOULE

Provider Business Mailing Address
First Line	:	PO BOX 1121
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-0254
Country	:	US
Telephone Number	:	541-672-2691
Fax Number	:	833-299-8415

Provider Business Practice Location Address
First Line	:	615 5TH ST
Second Line	:
City	:	BROOKINGS
State	:	OR
Zip	:	97415-9199
Country	:	US
Telephone Number	:	877-408-8941
Fax Number	:	541-813-2536

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

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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Directions to “ NICHOLAS SOULE ” Practice Location

Language	Start Address	Practice Location

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