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General NPI Number Information
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NPI Number | 1548211634
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Entity Type | Individual
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Provider Name | DOMINIQUE A NICKSON MD
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Gender | Male
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 8876 SYNERGY DR SUITE 100
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City | MCKINNEY
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State | TX
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Zip | 75070-1276
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Country | US
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Telephone | 972-547-0047
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Fax | 877-400-6329
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Provider Business Mailing Address
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Address Line | 8876 SYNERGY DR STE 100
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City | MCKINNEY
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State | TX
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Zip | 75070-1276
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Country | US
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Telephone | 972-547-0047
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Fax | 877-400-6329
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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 | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | L8866
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | L8866
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License Number State | TX
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