Individual
MR. NICHOLAS ALEXANDER PUKISH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
189 WALMART LN STE B, BILOXI, MS 39531-4564
(601) 368-6254
Mailing address
6255 W SUNSET BLVD FL 21, LOS ANGELES, CA 90028-7422
(323) 860-5200
(323) 467-7119
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA 9100880
FL
363AM0700X
Medical Physician Assistant
Primary
PA00845
MS
Other
Enumeration date
07/14/2006
Last updated
01/23/2025
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