Individual
KENNY L NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSN, APRN, PMHNP-BC
Contact information
Practice address
125 MUDDY TOES DR, ANDERSON, SC 29626-5349
(864) 353-3384
(864) 222-9715
Mailing address
113 SHADOWOOD CT, SENECA, SC 29678-1275
(864) 985-3915
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
27318
SC
Other
Enumeration date
05/04/2023
Last updated
05/04/2023
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