# WILLIAM DAVID NICKELL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1376826925
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 003357 | OH | — |
| 363A00000X | Physician Assistant | PAC1180 | ND | — |
| 363AM0700X | Medical Physician Assistant | 003357 | OH | — |
| 363AS0400X | Surgical Physician Assistant | 003357 | OH | Yes |

## Other

- **Enumeration date:** 09/20/2011
- **Last updated:** 09/24/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0085670 | — | OH |
| 01 | — | 12286408 | CIGNA/GREAT-WEST HEALTHCARE/SAGAMORE | — |