Healthcare Provider Details

I. General information

NPI: 1497672091
Provider Name (Legal Business Name): ELIZABETH NICHOLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 MOUNTAIN VIEW ESTATES RD
PARSONS WV
26287-8086
US

IV. Provider business mailing address

542 MOUNTAIN VIEW ESTATES RD
PARSONS WV
26287-8086
US

V. Phone/Fax

Practice location:
  • Phone: 304-940-5947
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number109449
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: