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General NPI Number Information
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NPI Number | 1134455256
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Entity Type | Organization
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Legal Business Name | RICHARD A NICHOLS, DPM, PA
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 1141 KELLER PKWY SUITE C
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City | KELLER
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State | TX
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Zip | 76248-1627
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Country | US
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Telephone | 817-741-4800
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Fax | 817-741-4840
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Provider Business Mailing Address
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Address Line | 1600 LANCASTER DR SUITE 102
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City | GRAPEVINE
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State | TX
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Zip | 76051-3579
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Country | US
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Telephone | 817-481-4000
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Fax | 817-421-0732
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Authorized Official
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Title or Position | PODIATRIST
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Name | RICHARD A NICHOLS
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Credential | DPM
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Telephone | 81748140000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 917
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number | 917
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 917
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License Number State | TX
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