Healthcare Provider Details

I. General information

NPI: 1073564050
Provider Name (Legal Business Name): CYNTHIA H. NICHOLS F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W COMMERCE ST
HERNANDO MS
38632-2240
US

IV. Provider business mailing address

124 W COMMERCE ST
HERNANDO MS
38632-2240
US

V. Phone/Fax

Practice location:
  • Phone: 662-429-5221
  • Fax: 662-429-7917
Mailing address:
  • Phone: 662-429-5221
  • Fax: 662-429-7917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR707295
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: