Individual
KATHRYN LOUISE NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
114 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1522
(336) 765-5470
(336) 499-5428
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-15673
NC
Other
Enumeration date
09/02/2022
Last updated
10/29/2025
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