Provider Demographics
NPI:1316088156
Name:NICHOLS, KATHERINE KERN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:KERN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:ELLEN
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2401 VILLAGE PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-4702
Mailing Address - Country:US
Mailing Address - Phone:334-749-8121
Mailing Address - Fax:334-749-6166
Practice Address - Street 1:2401 VILLAGE PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-4702
Practice Address - Country:US
Practice Address - Phone:334-749-8121
Practice Address - Fax:334-749-6166
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18435208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL18435OtherALABAMA MEDICAL LICENSE
AL18435OtherALABAMA CONTR SUBST CERT
AL510-27666OtherBCBS AL PROV # OPELIKA
AL515-17926OtherBCBS AL PROV # AUBURN
AL1210140OtherUNITED HEALTH PROV #
32572OtherAMERICAN BOARD PEDIATRICS
153293OtherAAP ID
BN0810538OtherDEA
AL18435OtherALABAMA MEDICAL LICENSE
153293OtherAAP ID