WILLIAM DAVID NICKELL (NPI# 1376826925) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376826925 |
| Entity Type | Individual |
| Full Name | WILLIAM DAVID NICKELL |
| Other Name | DAVE NICKELL |
| Credential | PA-C |
| Practice Address |
3533 Southern Blvd Ste 5650 Kettering OH 45429-1263 |
| Mailing Address |
3533 Southern Blvd Suite 5650 Kettering OH 45429-1264 |
| Practice Telephone | 9372943611 |
| Practice Fax Number | 9372949010 |
| Mailing Telephone | 9372943611 |
| Mailing Fax Number | 9372949010 |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2017-03-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | 003357 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
003357 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
003357 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CIGNA/GREAT-WEST HEALTHCARE/SAGAMORE | 12286408 | 01 | |
| OH | 0085670 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306901517 | William B Nickell | Plastic Surgery | 500 Cahaba Park Cir, Birmingham, AL 35242-5087 | 2006-12-27 |
| Street Address |
3533 SOUTHERN BLVD STE 5650 |
| City | KETTERING |
| State | OH |
| Zip Code | 45429-1263 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497902944 | Jennifer Roberts | Physician Assistant | 3533 Southern Blvd Ste 5650, Kettering, OH 45429-1263 | 2008-08-26 |
| 1104384577 | Daniel E Straiton | Physician Assistant | 3533 Southern Blvd Ste 5650, Kettering, OH 45429-1263 | 2019-03-05 |
| 1407343999 | Kimberly Ann Ekrem Rice | Registered Nurse | 3533 Southern Blvd Ste 5650, Kettering, OH 45429 | 2018-04-19 |
| 1851841084 | Kettering Cardiothoracic and Vascular Surgeons, Inc | Physician Assistant | 3533 Southern Blvd Ste 5650, Kettering, OH 45429-1263 | 2016-10-12 |
| 1841603735 | James Pitcher | Perfusionist | 3533 Southern Blvd Ste 5650, Kettering, OH 45429-1263 | 2014-06-09 |
| 1912227927 | Dwight Jonathan Slater | Surgery | 3533 Southern Blvd Ste 5650, Kettering, OH 45429 | 2010-06-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821576414 | Lauren Danielle Sivley | Nurse Practitioner | 3535 Sourthern Boulevard, Kettering, OH 45429 | 2018-08-06 |
| 1114446127 | Louai Al-samkari | Chiropractor | 1441 E. Stroop Rd., Kettering, OH 45429 | 2017-09-12 |
| 1407373756 | Benjamin Edward Adkins | Specialist/Technologist | 4116 Vinita Dr., Kettering, OH 45429 | 2017-08-28 |
| 1972036341 | James Kim | Student in an Organized Health Care Education/Training Program | 3535 Southern Boulevard, Kettering, OH 45429 | 2017-04-04 |
| 1023549847 | Adrienne Krysiak | Emergency Medicine | 3525 Southern Boulevard, Kettering, OH 45429 | 2017-03-23 |
| 1386021889 | Cassandra Mckoy | Counselor | 529 East Stroop Road, Kettering, OH 45429 | 2015-05-04 |
| 1417343088 | Candace Benoit | Obstetrics & Gynecology | 3533 Southern Blvd Ste 4600, Dayton, OH 45429 | 2015-04-10 |
| 1275933574 | Lee Schwieterman | Nurse Practitioner | 3535 Southern Blvd., 1 East, Kettering, OH 45429 | 2014-08-25 |
| 1497161947 | Robert Jonathon Fresch Jr. | Obstetrics & Gynecology | 3533 Southern Blvd Ste 3750, Kettering, OH 45429 | 2014-07-05 |
| 1821349812 | Lucas Brewer | Counselor | 1524 E Stroop Rd Ste 300, Kettering, OH 45429 | 2012-10-01 |
| Find all providers in zip 45429 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497902944 | Jennifer Roberts | Physician Assistant | 3533 Southern Blvd Ste 5650, Kettering, OH 45429-1263 | 2008-08-26 |
| 1992175798 | Megan Haas | Physician Assistant | 3533 Southern Blvd, Suite 5650, Kettering, OH 45429-1264 | 2015-10-06 |
| 1881096311 | Brennan L Kelly | Physician Assistant | 3700 Southern Blvd Ste 300, Kettering, OH 45429-1226 | 2014-09-16 |
| 1891077293 | Alliance Physician Inc | Physician Assistant | 3535 Southern Blvd, Suite B, Kettering, OH 45429-1221 | 2011-09-13 |
| 1467781310 | Ericka Lynn Mcconnaughey | Physician Assistant | 3533 Southern Blvd, Ste 3000, Kettering, OH 45429-1280 | 2009-12-23 |
| 1689798662 | Jason R Roller | Physician Assistant | 3533 Southern Blvd, Ste 2100, Kettering, OH 45429-1267 | 2007-03-16 |
| 1568460236 | Michael Rumschik | Physician Assistant | 3533 Southern Blvd, Ste 5650, Kettering, OH 45429-1264 | 2005-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508418260 | Collin Dees | Physician Assistant | Tripoint Medical Center, 7590 Auburn Road, Painesville, OH 44077 | 2019-07-12 |
| 1811469968 | Cody Tyler Delaney | Physician Assistant | 1711 27th St Ste 306, Portsmouth, OH 45662-2669 | 2018-12-28 |
| 1861936155 | Surgical Fusion, LLC | Physician Assistant | 605 N High St # 237, Columbus, OH 43215-2024 | 2016-12-06 |
| 1225481690 | Rebekah Keesee | Physician Assistant | 1045 Arundel Ave, Westerville, OH 43081-1188 | 2016-07-20 |
| 1568814382 | Kristen Cipolla | Physician Assistant | 1049 Scarlet Oak Dr Apt D, Hudson, OH 44236-4542 | 2016-07-05 |
| 1932560083 | Adam Peckinpaugh | Physician Assistant | 2109 Hughes Drive #450, Jobst Vascular Institute, Toledo, OH 43606-5102 | 2016-03-17 |
| 1710348701 | Alex Blake | Physician Assistant | 10743 S State Route 133, Blanchester, OH 45107-9435 | 2016-03-17 |
| 1215319926 | Richard Alan Stevenson | Physician Assistant | 187 Vine St, Fairborn, OH 45324-3324 | 2015-06-18 |
| 1548641038 | Matthew Hamley | Physician Assistant | 2315 Birch Trace Dr, Youngstown, OH 44515-4914 | 2015-06-10 |
| 1588094148 | Kevin W. Rotondo | Physician Assistant | 1732 Maple St, Wickliffe, OH 44092-2423 | 2013-11-19 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on WILLIAM DAVID NICKELL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.