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NPI Code Detail

MEDICARE: MS. NICOLE DENISE NICKENS MSN, A-GPNP-BC,

MEDICARE: MS. NICOLE DENISE NICKENS MSN, A-GPNP-BC,
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
1207RA0401XAddiction Medicine (Internal Medicine) PhysicianCNP020745OH
2363L00000XNurse PractitionerAPRN.CNP.020745OH
3163W00000XRegistered NurseRN346914OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609082486
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NICOLE DENISE NICKENS MSN, A-GPNP-BC,
Provider Business Mailing Address
First Line : 12395 MCCRACKEN RD
Second Line :
City : GARFIELD HTS
State : OH
Zip : 44125-2967
Country : US
Telephone Number : 216-587-6727
Fax Number :
Provider Business Practice Location Address
First Line : 12395 MCCRACKEN RD
Second Line :
City : GARFIELD HTS
State : OH
Zip : 44125-2967
Country : US
Telephone Number : 216-587-6727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2007
Last Update Date : 03/11/2026

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