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NPI Code Detail

MEDICARE: MRS. BONNIE SUE NICHOLS FNP-C

MEDICARE: MRS. BONNIE SUE NICHOLS FNP-C
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
1363LF0000XFamily Nurse PractitionerAP132326TX

General Provider Information

NPI Number : 1861943268
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BONNIE SUE NICHOLS FNP-C
Provider Business Mailing Address
First Line : PO BOX 848476
Second Line :
City : DALLAS
State : TX
Zip : 75284-8476
Country : US
Telephone Number : 254-202-9330
Fax Number : 254-202-9349
Provider Business Practice Location Address
First Line : 7702 CENTRAL PARK DR
Second Line :
City : WACO
State : TX
Zip : 76712-6535
Country : US
Telephone Number : 254-202-7710
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2016
Last Update Date : 11/28/2023

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