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General NPI Number Information
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NPI Number | 1356757793
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Entity Type | Individual
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Provider Name | HEATHER NICHOLSON NP
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Gender | Female
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 504 3RD AVE
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City | JASPER
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State | IN
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Zip | 47546-3503
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Country | US
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Telephone | 812-964-5750
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Fax | 812-964-5750
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Provider Business Mailing Address
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Address Line | 504 3RD AVE
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City | JASPER
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State | IN
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Zip | 47546-3503
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Country | US
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Telephone | 812-964-5750
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Fax | 812-964-5750
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28166000C
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71004996A
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License Number State | IN
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