Healthcare Provider Details

I. General information

NPI: 1699389544
Provider Name (Legal Business Name): KEVIN NICHOLS LP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8004 LANHAM LN
HOUSTON TX
77075-2653
US

IV. Provider business mailing address

8004 LANHAM LN
HOUSTON TX
77075-2653
US

V. Phone/Fax

Practice location:
  • Phone: 832-576-0296
  • Fax:
Mailing address:
  • Phone: 832-576-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number126383
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: