# DR. JARED WADE NICHOLS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1982018727
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | 2016007756 | MO | Yes |
| 207Q00000X | Family Medicine Physician | 2016007756 | MO | — |

## Other

- **Enumeration date:** 06/19/2014
- **Last updated:** 01/04/2022