KENNETH NICKSON (NPI# 1477669646) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477669646 |
| Entity Type | Individual |
| Full Name | KENNETH NICKSON |
| Credential | M.D |
| Practice Address |
4445 Magnolia Ave Riverside CA 92501-4135 |
| Mailing Address |
2100 Powell St Ste 900 Emeryville CA 94608-1826 |
| Practice Telephone | 9097883000 |
| Mailing Telephone | 5103502600 |
| Mailing Fax Number | 5108799100 |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2008-07-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | C33985 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00C339850 | 05 |
| Street Address |
4445 MAGNOLIA AVE |
| City | RIVERSIDE |
| State | CA |
| Zip Code | 92501-4135 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801897731 | Donald R Massee | Radiology | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2005-08-02 |
| 1215538392 | Nicole Barnard | Nurse Practitioner | 4445 Magnolia Ave, Riverside, CA 92501-4199 | 2020-11-04 |
| 1942808811 | Nelson Javier Maravilla | Nurse Anesthetist, Certified Registered | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2020-10-13 |
| 1801494026 | Clinton William Hart | Nurse Practitioner | 4445 Magnolia Ave, Riverside, CA 92501-4199 | 2020-10-09 |
| 1578179677 | Dallas Mckinley Bessette | Nurse Anesthetist, Certified Registered | 4445 Magnolia Ave, Riverside, CA 92501-4199 | 2020-09-23 |
| 1124641444 | Emely Rebekah Garcia | Anesthesiology | 4445 Magnolia Ave, Riverside, CA 92501-4199 | 2020-05-20 |
| 1447872429 | Seena Khosravi | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2020-05-12 |
| 1336761519 | Alexandra May Bock | Nurse Anesthetist, Certified Registered | 4445 Magnolia Ave, Riverside, CA 92501-4199 | 2020-05-11 |
| 1568084747 | Courtney Lynn Hipkin | Nurse Anesthetist, Certified Registered | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2020-05-11 |
| 1003438193 | Shalini Sunil Shah | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2020-05-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700437605 | Mary Horvatin | Technician | 1811 Rivera Strret, Riverside, CA 92501 | 2019-09-23 |
| 1366905473 | Timothy Daniel Collins | Student in an Organized Health Care Education/Training Program | Riverside Community Hospital, 4445 Magnolia Ave., Gme, Office, Riverside, CA 92501 | 2019-04-08 |
| 1346709672 | Lourdes Adame | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Ave - Gme Office, Riverside, CA 92501 | 2019-03-16 |
| 1740759067 | Kristina Ferris-celosse | Counselor | 2452 Wilshire St., Riverside, CA 92501 | 2018-11-15 |
| 1750888095 | Arunmozhi Aravagiri | Student in an Organized Health Care Education/Training Program | Riverside Community Hospital, Gme Office, 4445 Magnolia Ave., Riverside, CA 92501 | 2018-04-12 |
| 1720585847 | Alan Huynh | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Avenue., Gme Office, Riverside, CA 92501 | 2018-04-06 |
| 1538664834 | Wilson Paul Frasca | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Avenue, Riverside, CA 92501 | 2018-03-28 |
| 1851896575 | Geethu Gopinathan Nair | Student in an Organized Health Care Education/Training Program | Riverside Community Hospital, 4445 Magnolia Ave., Gme Office, Riverside, CA 92501 | 2018-03-26 |
| 1316465560 | Thilini Anne Abeygunaratne | Marriage & Family Therapist | 1950 Market Street, Riverside, CA 92501 | 2017-09-07 |
| 1194257410 | Melissa Chitwood | Assistant Behavior Analyst | 3078 Cedar St., Riverside, CA 92501 | 2017-03-28 |
| Find all providers in zip 92501 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780038505 | Nash David Martinez | Emergency Medicine | 10800 Magnolia Ave Dept of Emergency Medicine, Kaiser Permanente Hospital, Riverside, CA 92505 | 2016-04-18 |
| 1669848222 | Desiree Ann Pasillas | Emergency Medicine | 3257 Pontiac Ave, Riverside, CA 92509-4430 | 2015-08-18 |
| 1982997250 | Daniel Ng | Emergency Medicine | 4445 Magnolia Ave Dept Of, Riverside, CA 92501-4135 | 2011-05-19 |
| 1710202924 | Jared J Marcucci | Emergency Medicine | 399 Blythe Rd, Riverside, IL 60546-1703 | 2010-03-30 |
| 1548448970 | Roberta Jean Dunn-dixon | Emergency Medicine | 4443 Magnolia Ave, Emergency Department, Riverside, CA 92501 | 2008-02-07 |
| 1124057757 | Horace Charles Stevens | Emergency Medicine | 4581 Luther St, Riverside, CA 92504-2231 | 2006-07-03 |
| 1083612824 | Ernest Woodhouse | Emergency Medicine | 4440 Magnolia Ave., Riverside, CA 92501 | 2005-07-13 |
| 1396249793 | Ashkan Morim | Emergency Medicine | 4445 Magnolia Ave, Riverside, CA 92501 | 2018-03-20 |
| 1417488792 | Rebecca C. Bishop | Emergency Medicine | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2017-03-27 |
| 1033640073 | John Christian Canet Costumbrado | Emergency Medicine | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2017-03-22 |
| Find all providers in RIVERSIDE | ||||
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| 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.