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Individual

REGINA SHANELLE NICKELSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-BC

Contact information

Practice address
2701 DAVIS STREET, MERIDIAN, MS 39301-5708
(601) 693-0118
(601) 553-8175
Mailing address
2701 DAVIS STREET, MERIDIAN, MS 39301-5708
(601) 693-0118
(601) 553-8175

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-099036
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
R865667
BOARD OF NURSING
MS
Enumeration date
07/17/2009
Last updated
11/07/2012
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