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NPI Code Detail

MEDICARE: MELISSA GRACE NICHOLSON RNCPCP

MEDICARE: MELISSA GRACE NICHOLSON RNCPCP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner521670TX

General Provider Information

NPI Number : 1083887335
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA GRACE NICHOLSON RNCPCP
Provider Business Mailing Address
First Line : 2280 HIGHLAND VILLAGE RD STE 130
Second Line :
City : HIGHLAND VILLAGE
State : TX
Zip : 75077-7189
Country : US
Telephone Number : 972-317-6000
Fax Number : 972-317-6011
Provider Business Practice Location Address
First Line : 2280 HIGHLAND VILLAGE RD STE 130
Second Line :
City : HIGHLAND VILLAGE
State : TX
Zip : 75077-7189
Country : US
Telephone Number : 972-317-6000
Fax Number : 972-317-6011
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2008
Last Update Date : 04/08/2008

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