Healthcare Provider Details

I. General information

NPI: 1013194364
Provider Name (Legal Business Name): NICOLE STOCKSTILL M.S., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7784 INNOVATION PARK DR
BATON ROUGE LA
70820-7006
US

IV. Provider business mailing address

36298 E PINE GROVE CT
PRAIRIEVILLE LA
70769-3466
US

V. Phone/Fax

Practice location:
  • Phone: 225-343-4232
  • Fax: 225-343-4233
Mailing address:
  • Phone: 225-288-0079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number4389A
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: