Healthcare Provider Details

I. General information

NPI: 1649201484
Provider Name (Legal Business Name): RACHEL JEAN OSINA NICHOLS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E RICHARDS ST
TYLER TX
75702-6153
US

IV. Provider business mailing address

1350 E RICHARDS ST
TYLER TX
75702-6153
US

V. Phone/Fax

Practice location:
  • Phone: 903-531-9455
  • Fax: 903-526-3118
Mailing address:
  • Phone: 903-531-9455
  • Fax: 903-526-3118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM1982
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: