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NPI Code Detail

MEDICARE: DR. KELLY B NICHOLS MD

MEDICARE: DR. KELLY B NICHOLS MD
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
1207V00000XObstetrics & Gynecology Physician2004012268MO

General Provider Information

NPI Number : 1851396691
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY B NICHOLS MD
Provider Business Mailing Address
First Line : 8380 N TULLIS AVE STE 300
Second Line :
City : KANSAS CITY
State : MO
Zip : 64158-5114
Country : US
Telephone Number : 816-741-9122
Fax Number : 816-741-9665
Provider Business Practice Location Address
First Line : 8380 N. TULLIS AVENUE, SUITE 300
Second Line : STE 310
City : KANSAS CITY
State : MO
Zip : 64158-5114
Country : US
Telephone Number : 816-741-9122
Fax Number : 816-741-9665
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2005
Last Update Date : 04/29/2019

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Directions to “ DR. KELLY B NICHOLS MD” Practice Location

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