KELLEY ANNE NICHOLSON (NPI# 1962059832) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962059832 |
| Entity Type | Individual |
| Full Name | KELLEY ANNE NICHOLSON |
| Practice Address |
1235 Mchenry Ave Ste A&b Modesto CA 95350-5370 |
| Mailing Address |
4000 Tierra Lago Dr Modesto CA 95356-8743 |
| Practice Telephone | 2095274597 |
| Mailing Telephone | 5103256790 |
| Enumeration Date | 2019-08-24 |
| Last Update Date | 2019-08-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| Street Address |
1235 MCHENRY AVE STE A&B |
| City | MODESTO |
| State | CA |
| Zip Code | 95350-5370 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972677839 | Shelly Denise Booker | Counselor | 1235 Mchenry Ave Ste A&b, Modesto, CA 95350-5370 | 2006-11-20 |
| 1740804079 | Natali Reyes Lopez | Counselor | 1235 Mchenry Ave Ste A&b, Modesto, CA 95350-5370 | 2020-06-02 |
| 1447894910 | Crystal Zapien | Counselor | 1235 Mchenry Ave Ste A&b, Modesto, CA 95350-5370 | 2019-10-29 |
| 1265074520 | Marina Eden Garcia | Licensed Vocational Nurse | 1235 Mchenry Ave Ste A&b, Modesto, CA 95350-5370 | 2019-10-08 |
| 1891344198 | Rochelle Azevedo | Counselor | 1235 Mchenry Ave Ste A&b, Modesto, CA 95350-5370 | 2019-09-09 |
| 1538716220 | Kayla Michael Flores | Licensed Vocational Nurse | 1235 Mchenry Ave Ste A&b, Modesto, CA 95350-5370 | 2019-08-19 |
| 1578119889 | Vanessa Flores Martinez | Licensed Vocational Nurse | 1235 Mchenry Ave Ste A&b, Modesto, CA 95350-5370 | 2019-08-13 |
| 1841856408 | Stephanie Barrios | Counselor | 1235 Mchenry Ave Ste A&b, Modesto, CA 95350-5370 | 2019-05-18 |
| 1821652512 | Marcus Piro | Counselor | 1235 Mchenry Ave Ste A&b, Modesto, CA 95350-5370 | 2019-04-28 |
| 1891257184 | Kurt Demetrius Mays | Counselor | 1235 Mchenry Ave Ste A&b, Modesto, CA 95350-5370 | 2019-04-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164020459 | Karina Montes Rodriguez | Case Manager/Care Coordinator | Cip 1540 Florida Ave, Suite 212, Modesto, CA 95350 | 2020-10-09 |
| 1134737315 | Dr. Jeffrey A. Saladin, Dental Corporation | Dentist | 2057 Tully Road, Suite A, Modesto, CA 95350 | 2020-07-14 |
| 1588211254 | Karla Junuen Toscano | Licensed Vocational Nurse | 1235 Mchenry Ave. Suites A&b, Modesto, CA 95350 | 2019-08-19 |
| 1831694769 | Loretta Myers-weber | Nurse Practitioner | 1510 Florida Ave Ste A, Modesto, CA 95350 | 2018-03-23 |
| 1720599632 | Coral Alejandra Amador | Counselor | 1700 Mchenry Village Way, Suite 11b, Modesto, CA 95350 | 2017-10-18 |
| 1053820522 | Pannu and Henne Dental Corp. | Dentist | 3219 Mc Henry Ave, Suite E, Modesto, CA 95350 | 2017-09-27 |
| 1346779709 | Kevin Sotelo | Behavior Technician | 2630 W Rumble Road, Modesto, CA 95350 | 2017-06-08 |
| 1255869566 | Hoa Xuan Phan | Family Medicine | 1441 Florida Ave Ste 200, Modesto, CA 95350 | 2017-05-31 |
| 1356881163 | Brady S Marshall | Dentist | 201 E. Orangeburg Avenue, Suite C, Modesto, CA 95350 | 2017-02-27 |
| 1750755476 | Caremore Health Plan | Nurse Practitioner | 1234 Mchenry Avenue, Modesto, CA 95350 | 2015-11-18 |
| Find all providers in zip 95350 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063055812 | Diana Harrison | Counselor | 1235 Mchenry Ave # A&b, Modesto, CA 95350-5370 | 2019-10-24 |
| 1710468095 | Dominic Maurice Casaca | Counselor | 616 Perfidia Ave, Modesto, CA 95351-4135 | 2018-08-24 |
| 1659867513 | Amalia Tapia | Counselor | 1235 Mchenry Ave Unit A&b, Modesto, CA 95350-5370 | 2018-07-03 |
| 1265934301 | Ben Hopp | Counselor | 123 Mchenry Ave, Modesto, CA 95354-0541 | 2018-03-05 |
| 1447772488 | Selenee Marie Flores | Counselor | 1235 Mchenry Ave # Ab, Modesto, CA 95350-5370 | 2017-07-12 |
| 1801325477 | Holly Elizabeth Moore | Counselor | 2000 W Briggsmore Ave Ste 1, Modesto, CA 95350-3839 | 2017-06-07 |
| 1942737507 | Gloria Edith Robles | Counselor | 3125 Mchenry Ave Ste D, Modesto, CA 95350-1451 | 2017-05-15 |
| 1184088668 | Michelle Lucas | Counselor | 1421 Mosswood Ln, Modesto, CA 95355-1555 | 2016-04-11 |
| 1407229248 | Roy Douglas | Counselor | 1235 Mcherney, A and B, Modesto, CA 95350-9411 | 2015-11-02 |
| 1639541394 | Dynese Lee Addotta | Counselor | 1520 Goldenwood Dr, Modesto, CA 95350-3865 | 2015-10-21 |
| Find all providers in MODESTO | ||||
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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.