Basic Information
| Provider Information | |||||||||
| NPI: | 1356309710 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICHOLS | ||||||||
| FirstName: | KIMBERLEY | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 143 W FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275162539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199668596 | ||||||||
| FaxNumber: | 9198435515 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MANNING DR. | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199668596 | ||||||||
| FaxNumber: | 9198435515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 09/26/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0101238564 | VA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | 0101238564 | VA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207L00000X | 200401424 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 5917900 | 05 | NC | MEDICAID | 010214360 | 05 | VA | MEDICAID |