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KAITLYN NICHOLS M.A.
NPI 1154875789
Psychologist - Clinical in Fresno, CA

Active since August 11, 2016PECOS Enrolled
3443 W SHAW AVE, FRESNO, CA 93711(559) 271-1186 Get Directions Write a Review

NPPES record last updated: September 16, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 16, 2025, Jan 18, 2022, Aug 11, 2016 (3 updates tracked since 2016).

About Kaitlyn Nichols M.a. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KAITLYN NICHOLS M.A. (NPI 1154875789) is an individual clinical provider in Fresno, California, licensed in California (30721) and active in the NPI registry since August 2016. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1154875789
Entity TypeIndividualFemale
Primary Taxonomy103TC0700X
Provider Legal NameKAITLYN NICHOLSCredential: M.A.
Location Address3443 W SHAW AVEFresno, CA 93711-3249
Mailing Address3443 W Shaw AveFresno, CA 93711-3249 · (559) 271-1186
Phone(559) 271-1186
Sole ProprietorYes
Enumeration DateAugust 11, 2016
Last NPPES UpdateSeptember 16, 20253 updates tracked since enumeration
NPPES CertifiedSeptember 16, 2025
✔ NPI 1154875789 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
Licenses✔ Licensed in CA · 30721✔ Licensed in CA · 94022754
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
3443 W SHAW AVE, Fresno, CA 93711
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kaitlyn Nichols M.a. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kaitlyn Nichols reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Permanente Medical Group Inc
115 mi
Internal Medicine
7373 WEST LANE
Stockton, CA 95210
  • Reassigned Medicare billing, California enrollment
  • 20,078 clinicians in this Medicare group
NPI 1548343510 (209) 476-2000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 93711 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$176.60 typical visit price
range $58.87 – $176.60
Typical copayment $44.15 (range $14.71 – $44.15)
Most-billed visit code 99205
Established Patient
$103.36 typical visit price
range $19.28 – $144.60
Typical copayment $25.84 (range $4.82 – $36.15)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MISS SANDRA MANSOUR M.A.
Psychologist (Clinical Child & Adolescent)
3443 W SHAW AVE, SULLIVAN CENTER FOR CHILDREN
FRESNO, CA 93711
Fresno County (559) 271-1176
BRITTNY TORRENCE
Psychologist (Clinical)
3443 W SHAW AVE
FRESNO, CA 93711
Fresno County (559) 271-1186
RAYMOND STEPHEN CASTRO JR.
Psychologist
3443 W SHAW AVE
FRESNO, CA 93711
Fresno County (559) 271-1186
CORE CONDITIONS, INC.
Community Based Residential Treatment Facility, Mental Illness
3443 W SHAW AVE
FRESNO, CA 93711
Fresno County (559) 277-3494
PAMELA L DEROIAN PHD
Psychologist (Clinical)
3443 W SHAW AVE
FRESNO, CA 93711
Fresno County (559) 271-1186
MELISSA WAGNER M.A.
Psychologist (Clinical)
3443 W SHAW AVE
FRESNO, CA 93711
Fresno County (559) 271-1186
DR. KATHERINE ALEXANDRA REDWINE PH.D.
Psychologist
3443 W SHAW AVE
FRESNO, CA 93711
Fresno County (559) 271-1186
SULLIVAN CENTER FOR CHILDREN A PSYCHOLOGICAL CORPORATION
Psychologist (Clinical)
3443 W SHAW AVE
FRESNO, CA 93711
Fresno County (559) 271-1186

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kaitlyn Nichols's NPI number?

The NPI number for Kaitlyn Nichols is 1154875789. It was assigned to this individual provider in the NPPES registry on August 11, 2016.

Where is Kaitlyn Nichols located?

Kaitlyn Nichols practices at 3443 W Shaw Ave, Fresno, CA 93711. The listed phone number is (559) 271-1186.

What is Kaitlyn Nichols's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Kaitlyn Nichols enrolled in Medicare?

Yes. Kaitlyn Nichols is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kaitlyn Nichols's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kaitlyn Nichols reassigns Medicare benefits to Permanente Medical Group Inc (Stockton, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kaitlyn Nichols's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kaitlyn Nichols was last updated on September 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.