Healthcare Provider Details

I. General information

NPI: 1144283664
Provider Name (Legal Business Name): ALAN NICHOLS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 EDWARDS
MERKEL TX
79536-3803
US

IV. Provider business mailing address

PO BOX 2435
ALBANY TX
76430-8020
US

V. Phone/Fax

Practice location:
  • Phone: 325-928-0014
  • Fax: 325-893-4035
Mailing address:
  • Phone: 325-762-2447
  • Fax: 325-893-4035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number684692
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP113748
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP113748
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: