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General NPI Number Information
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NPI Number | 1275916744
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Entity Type | Organization
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Legal Business Name | TREASURED PEDIATRIC CARE HILARY NICHOLSON APRN-CNP, PLLC
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Dates
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Enumeration Date | 07/02/2015
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 1101 W MAIN ST SUITE 112
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City | COLLINSVILLE
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State | OK
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Zip | 74021-3112
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Country | US
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Telephone | 918-553-8613
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Fax | 918-371-2332
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Provider Business Mailing Address
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Address Line | 1101 W MAIN ST SUITE 112
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City | COLLINSVILLE
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State | OK
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Zip | 74021-3112
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Country | US
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Telephone | 918-553-8613
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Fax | 918-371-2332
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Authorized Official
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Title or Position | OWNER/ PROVIDER
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Name | MRS. HILARY D NICHOLSON
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Credential | APRN-CNP
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Telephone | 918-553-8613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0067311
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License Number State | OK
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