Healthcare Provider Details

I. General information

NPI: 1932737459
Provider Name (Legal Business Name): JOSHUA HARVEY NICHOLS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9835 N LAKE CREEK PKWY
AUSTIN TX
78717-6210
US

IV. Provider business mailing address

9835 N LAKE CREEK PKWY
AUSTIN TX
78717-6210
US

V. Phone/Fax

Practice location:
  • Phone: 501-288-2341
  • Fax:
Mailing address:
  • Phone: 501-288-2341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberU6153
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberV5112
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: