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NPI Code Detail

MEDICARE: ANDREA NICKERSON

MEDICARE: ANDREA NICKERSON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1841065661
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA NICKERSON
Provider Business Mailing Address
First Line : 18600 E 37TH TER S
Second Line :
City : INDEPENDENCE
State : MO
Zip : 64057-1707
Country : US
Telephone Number : 816-298-5371
Fax Number :
Provider Business Practice Location Address
First Line : 901 N 8TH ST
Second Line :
City : KANSAS CITY
State : KS
Zip : 66101-2706
Country : US
Telephone Number : 913-568-1354
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2023
Last Update Date : 11/21/2023

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Directions to “ ANDREA NICKERSON ” Practice Location

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