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General NPI Number Information
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NPI Number | 1740173236
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Entity Type | Individual
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Provider Name | MINDY NICHOLS
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Gender | Female
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 901 WASHINGTON STREET, PORTSMOUTH, OH, USA
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City | PORTSMOUTH
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State | OH
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Zip | 45662
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Country | US
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Telephone | 740-442-7637
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Fax | 740-442-7637
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Provider Business Mailing Address
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Address Line | 225 CARLTON DAVIDSON LN
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City | COAL GROVE
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State | OH
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Zip | 45638-2924
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Country | US
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Telephone |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN.188599
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License Number State | OH
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