Healthcare Provider Details

I. General information

NPI: 1629889068
Provider Name (Legal Business Name): NICOLE INMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10857 KUYKENDAHL RD STE 210
SPRING TX
77382-2936
US

IV. Provider business mailing address

117 PARK CIR
MONTGOMERY TX
77356-5937
US

V. Phone/Fax

Practice location:
  • Phone: 832-869-4818
  • Fax:
Mailing address:
  • Phone: 631-885-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number651790
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number922968
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1189814
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: