Healthcare Provider Details

I. General information

NPI: 1467372235
Provider Name (Legal Business Name): ANDREA P NICHOLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4171 LOMAC ST STE E-1
MONTGOMERY AL
36106-2945
US

IV. Provider business mailing address

4171 LOMAC ST STE E-1
MONTGOMERY AL
36106-2945
US

V. Phone/Fax

Practice location:
  • Phone: 904-762-8175
  • Fax:
Mailing address:
  • Phone: 904-762-8175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number202500004280
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: