Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Grant S Nichols III, PA-C

Individual provider Electroneurodiagnostic Specialist/Technologist · NPI 1891051223

Grant S Nichols III, PA-C is a Physician Assistant in Colorado Springs, Colorado. Qualified in 2009, 17 years ago. Practices with Poudre Valley Medical Group LLC, a 2,416-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Colorado.

Years since qualifying
17
Licensed in
CO
In the registry since
2012
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

2685 Dublin Blvd
Colorado Springs, CO 80918-1358
Phone: (719) 592-9890
Fax: (719) 264-7908
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 300 Colorado Ave, Pueblo, CO 81004-2006 — (719) 543-8711

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA.0004492 (CO)
Electroneurodiagnostic Specialist/Technologist Taxonomy 246ZE0600X

Record details

NPI number1891051223
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedApril 10, 2012
Last updated in NPPESDecember 30, 2024
Certification dateDecember 30, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2009 (17 years in practice)
Group practice Poudre Valley Medical Group Llc — 2416 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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