Provider Demographics
NPI:1760770556
Name:ADAMS, NICOLE L (DPM)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:L
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:KESSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:4516 NE 102ND ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-5993
Mailing Address - Country:US
Mailing Address - Phone:623-202-5007
Mailing Address - Fax:360-326-1868
Practice Address - Street 1:1401 SE 164TH AVE STE 130
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9612
Practice Address - Country:US
Practice Address - Phone:360-524-3495
Practice Address - Fax:360-326-1868
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO61334283213ES0103X
AZ0771213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ856348Medicaid