Healthcare Provider Details

I. General information

NPI: 1730754524
Provider Name (Legal Business Name): ARIEL NICOLE NICKERSON CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. ARIEL NICOLE CAMPBELL

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9309 BELAIR RD STE D
NOTTINGHAM MD
21236-1605
US

IV. Provider business mailing address

9309 BELAIR RD STE D
NOTTINGHAM MD
21236-1605
US

V. Phone/Fax

Practice location:
  • Phone: 410-505-7952
  • Fax:
Mailing address:
  • Phone: 443-668-2272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR209249
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: