Provider Demographics
NPI:1861591562
Name:NICKELS, DAVID ANDREW (MD,)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:NICKELS
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901
Mailing Address - Country:US
Mailing Address - Phone:865-541-8895
Mailing Address - Fax:865-633-4808
Practice Address - Street 1:2018 CLINCH AVE, SOUTH TOWER
Practice Address - Street 2:2ND FLOOR
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916
Practice Address - Country:US
Practice Address - Phone:865-971-7400
Practice Address - Fax:865-541-8611
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000264202080P0205X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3090947Medicaid
TN3029183OtherBCBS