Healthcare Provider Details

I. General information

NPI: 1942618459
Provider Name (Legal Business Name): ARICA NICKLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 3RD ST SE STE 201
HURON SD
57350-2064
US

IV. Provider business mailing address

613 E 17TH ST
YANKTON SD
57078-2309
US

V. Phone/Fax

Practice location:
  • Phone: 605-554-0858
  • Fax: 605-610-4063
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSD-CNPCP000875
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA137585
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: