# KIMBERLY NICHELSON DPM

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568183846
- **Authorized official:** KIMBERLY M NICHELSON DPM (CEO)
- **Authorized official phone:** (419) 750-0041

## Contact information

- **Practice address:** 630 E RIVER ST, ELYRIA, OH 44035-5902
- **Practice address phone:** (419) 750-0041
- **Mailing address:** 108 TRAILHEAD LN, BEREA, OH 44017-1099
- **Mailing address phone:** (419) 750-0041

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 09/06/2022
- **Last updated:** 09/06/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 36.003767 | STATE LICENSE | OH |