Healthcare Provider Details

I. General information

NPI: 1619082294
Provider Name (Legal Business Name): RICHARD ALAN NICHOLS PA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LANCASTER DR SUITE 102
GRAPEVINE TX
76051-3579
US

IV. Provider business mailing address

1600 LANCASTER SUITE 102
GRAPEVINE TX
76051
US

V. Phone/Fax

Practice location:
  • Phone: 817-481-4000
  • Fax: 817-421-0732
Mailing address:
  • Phone: 817-481-4000
  • Fax: 817-421-0732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number917
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: