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NPI Code Detail

MEDICARE: MRS. JULIE ANN NICKERSON

MEDICARE: MRS. JULIE ANN NICKERSON
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1114566197
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JULIE ANN NICKERSON
Provider Business Mailing Address
First Line : 16629 WILD HORSE CREEK RD
Second Line :
City : CHESTERFIELD
State : MO
Zip : 63005-1627
Country : US
Telephone Number : 314-640-9105
Fax Number :
Provider Business Practice Location Address
First Line : 16629 WILD HORSE CREEK RD
Second Line :
City : CHESTERFIELD
State : MO
Zip : 63005-1627
Country : US
Telephone Number : 314-640-9105
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2019
Last Update Date : 12/21/2023

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Directions to “ MRS. JULIE ANN NICKERSON ” Practice Location

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