Look up the most recent NPI and PECOS records

Kenneth Nickson

Emergency Medicine

Allopathic & Osteopathic Physicians

4445 Magnolia Ave, Riverside, CA 92501-4135

PECOS Enrollment

Based on the most recent information from CMS, provider Kenneth Nickson does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1477669646
Provider Type
Individual
Full Name
Nickson, Kenneth
Credential
M.D

Gender
Male
Sole Proprietor
No
Enumeration Date
8/21/2006
Last Updated
7/18/2008

Contact Information

Practice Location

4445 Magnolia Ave, Riverside, CA 92501-4135

(909) 788-3000

Unlisted Fax

Mailing Location

2100 Powell St, Ste 900, Emeryville, CA 94608-1826

(510) 350-2600

(510) 879-9100

Provider Taxonomies

Code	Description	License
Code 207P00000X Primary	Description Emergency Medicine Allopathic & Osteopathic Physicians	License C33985 California

Provider Identifiers

ID	Description	Issuer
ID 00C339850	Description Medicaid	Issuer Unlisted California

Kenneth Nickson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Gustafsson, Bo Marcus

Fargusson, Joseph

Nguyen, Thien Minh

Chan, Eugene T.

Guth, Richard Harland

Teles, Samuel David

Schoenberg, Benjamen Elliot

Johnson, Kenneth

Moubarek, John Labeeb

Agudelo, Adrian Zabdiel