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General NPI Number Information
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NPI Number | 1366258766
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Entity Type | Individual
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Provider Name | NICK ALLEN MADDOX
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Gender | Male
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 601 W LEOTA ST
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City | NORTH PLATTE
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State | NE
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Zip | 69101-6525
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Country | US
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Telephone | 308-568-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 603 WILDWOOD LN
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City | NEBRASKA CITY
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State | NE
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Zip | 68410-3352
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Country | US
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Telephone | 402-209-1953
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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