Healthcare Provider Details

I. General information

NPI: 1225002215
Provider Name (Legal Business Name): KRISTIN DAWN NICHOLSON MS, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SETON CENTER PKWY SUITE 175
AUSTIN TX
78759-5295
US

IV. Provider business mailing address

12349 METRIC BLVD APARTMENT 812
AUSTIN TX
78758-2585
US

V. Phone/Fax

Practice location:
  • Phone: 512-439-1940
  • Fax: 512-439-1944
Mailing address:
  • Phone: 512-968-6711
  • Fax: 512-439-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: