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General NPI Number Information
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NPI Number | 1063745602
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Entity Type | Individual
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Provider Name | EDWARD CLAY NICHOLS FNP
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Gender | Male
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 3326 FRONT ST
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City | WINNSBORO
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State | LA
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Zip | 71295-6487
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Country | US
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Telephone | 318-435-7333
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Fax | 318-435-9061
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Provider Business Mailing Address
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Address Line | 2375 HIGHWAY 130
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City | WINNSBORO
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State | LA
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Zip | 71295-7704
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Country | US
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Telephone | 318-435-4064
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APO5939
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License Number State | LA
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