Healthcare Provider Details

I. General information

NPI: 1184078636
Provider Name (Legal Business Name): NICOLE ATKINSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 PARK BEND DR STE 300
AUSTIN TX
78758-5674
US

IV. Provider business mailing address

PO BOX 73627
HOUSTON TX
77273-3627
US

V. Phone/Fax

Practice location:
  • Phone: 512-382-1933
  • Fax:
Mailing address:
  • Phone: 832-249-3721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10452
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: