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Individual
WILLIAM DAVID NICKELL
Active
Individual
WILLIAM DAVID NICKELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
003357
OH
363A00000X
Physician Assistant
PAC1180
ND
363AM0700X
Medical Physician Assistant
003357
OH
363AS0400X
Surgical Physician Assistant
Primary
003357
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0085670
—
OH
01
—
12286408
CIGNA/GREAT-WEST HEALTHCARE/SAGAMORE
—
Enumeration date
09/20/2011
Last updated
09/24/2025
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