Healthcare Provider Details

I. General information

NPI: 1477253169
Provider Name (Legal Business Name): NIKOLAS B TURNER MS, ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UTSA CIR
SAN ANTONIO TX
78249-1644
US

IV. Provider business mailing address

9810 OVERLOOK CYN
SAN ANTONIO TX
78245-4818
US

V. Phone/Fax

Practice location:
  • Phone: 561-545-6629
  • Fax:
Mailing address:
  • Phone: 561-545-6629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberAT7867
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: