| Alexa Victoria Nickel, APRN | |
|
1200 E 3900 S Unit G175, Salt Lake City, UT 84124-1300 | |
| (801) 268-7405 | |
| (801) 268-7435 |
| Full Name | Alexa Victoria Nickel |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner |
| Experience | 6 Years |
| Location | 1200 E 3900 S Unit G175, Salt Lake City, Utah |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811488976 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 163W00000X | Registered Nurse | 9127639-3102 (Utah) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 9127639-4405 (Utah) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| St Mark's Hospital | Salt lake city, UT | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Mountainstar Specialty Services Llc | 4688767551 | 30 |
| Canyon Healthcare Inc | 8123368925 | 14 |
| Entity Name | Mountainstar Specialty Services Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1265638357 PECOS PAC ID: 4688767551 Enrollment ID: O20070908000097 |
| Entity Name | Canyon Healthcare Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1649748559 PECOS PAC ID: 8123368925 Enrollment ID: O20190313002843 |
| Mailing Address | Practice Location Address |
|---|---|
| Alexa Victoria Nickel, APRN Po Box 100253, Atlanta, GA 30384-0253 Ph: () - | Alexa Victoria Nickel, APRN 1200 E 3900 S Unit G175, Salt Lake City, UT 84124-1300 Ph: (801) 268-7405 |
Mrs. Lisa Ann Runyon, CPNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 100 N Medical Dr, Trauma Services, Salt Lake City, UT 84113 Phone: 801-662-2993 Fax: 801-662-2999 | |
Madeline Ann Thayer, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 100 N Mario Capecchi Dr, Salt Lake City, UT 84113 Phone: 801-662-3600 | |
Emma Fong, APRN Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 3802 S 700 E, Salt Lake City, UT 84106 Phone: 801-264-6000 | |
Ashlee Brynn Fenton, FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1160 E 3900 S Ste G200, Salt Lake City, UT 84124 Phone: 801-268-7766 | |
Donna M. Wahoff-stice, APRN, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 615 Arapeen Dr, 100, Salt Lake City, UT 84108 Phone: 801-581-7761 | |
Linda M Lambert, A.P.R.N. Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 100 N Medical Dr, Salt Lake City, UT 84113 Phone: 801-662-1000 | |
Ms. Ann A. K. Kamp, APRN Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 100 N Medical Dr, Salt Lake City, UT 84113 Phone: 801-662-1000 Fax: 801-662-4166 |