MEDICARE: JOY C NICHOLS CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN150871	GA
2	363LF0000X	Family Nurse Practitioner	1-123243	AL

General Provider Information

NPI Number	:	1659608834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY C NICHOLS CRNP

Provider Business Mailing Address
First Line	:	PO BOX 310
Second Line	:
City	:	ROANOKE
State	:	AL
Zip	:	36274-0310
Country	:	US
Telephone Number	:	334-338-2763
Fax Number	:	334-863-7415

Provider Business Practice Location Address
First Line	:	1026 LAFAYETTE HWY
Second Line	:
City	:	ROANOKE
State	:	AL
Zip	:	36274-7250
Country	:	US
Telephone Number	:	334-863-7410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2009
Last Update Date	:	05/08/2018

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