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Individual
STEPHANIE NICKERSON
Active
Individual
STEPHANIE NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024177488
VA
363LF0000X
Family Nurse Practitioner
Primary
0024177488
VA
363LF0000X
Family Nurse Practitioner
207247-6
MN
363LF0000X
Family Nurse Practitioner
AP131784
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
368109001
—
TX
01
—
8328MA
BCBS
TX
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
Enumeration date
06/12/2012
Last updated
05/09/2025
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