MARY NICHOLAS MD
NPI 1538929302
Student in an Organized Health Care Education/Training Program in Jackson, TN

Q: What is Mary Nicholas's NPI number?

The NPI number for Mary Nicholas is 1538929302. It was assigned to this individual provider in the NPPES registry on March 20, 2024.

Q: What is Mary Nicholas's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Mary Nicholas was last updated on March 20, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.

Active since March 20, 2024PECOS Enrolled

294 SUMMAR DR, JACKSON, TN 38301(731) 423-1932(731) 660-8739 Get Directions Write a Review

NPPES record last updated: March 20, 2024. Verified against the NPPES registry weekly; last sync: November 08, 2026.

On this page

About Mary Nicholas Md NPPES

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

MARY NICHOLAS MD (NPI 1538929302) is an individual student in an organized health care education/training program in Jackson, Tennessee and active in the NPI registry since March 2024. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1538929302

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameMARY NICHOLASCredential: MD

Location Address294 SUMMAR DRJackson, TN 38301-3915

Mailing Address294 Summar DrJackson, TN 38301-3915 · (731) 423-1932 · Fax (731) 660-8739

Phone(731) 423-1932

Fax(731) 660-8739

Sole ProprietorNo

Enumeration DateMarch 20, 2024

NPPES CertifiedMarch 20, 2024

✔ NPI 1538929302 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

294 SUMMAR DR, Jackson, TN 38301

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mary Nicholas Md 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.

Other Providers at the Same Location NPPES 20

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

JOAN CRENSHAW MD

Student in an Organized Health Care Education/Training Program