Healthcare Provider Details

I. General information

NPI: 1508877267
Provider Name (Legal Business Name): NICOLE LEE KROLL FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE LEE MOORE RN

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8447 JOHN SHARP PKWY
BRYAN TX
77807-1552
US

IV. Provider business mailing address

8447 JOHN SHARP PKWY
BRYAN TX
77807-1552
US

V. Phone/Fax

Practice location:
  • Phone: 979-436-0291
  • Fax: 979-436-0102
Mailing address:
  • Phone: 361-579-0315
  • Fax: 361-579-0325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP115032
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP115032
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP115032
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: