Healthcare Provider Details

I. General information

NPI: 1215306337
Provider Name (Legal Business Name): MS. KRISTA NICHOLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PROSPERITY FARMS RD STE D
NORTH PALM BEACH FL
33408-5212
US

IV. Provider business mailing address

136 LAKESHORE DR APT 310
NORTH PALM BEACH FL
33408-3634
US

V. Phone/Fax

Practice location:
  • Phone: 561-247-0289
  • Fax:
Mailing address:
  • Phone: 561-346-9174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA20568
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: