Individual
MR. KARLTON E NICHOLSON I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHMP
Contact information
Practice address
1360 N BULLARD AVE STE 200, GOODYEAR, AZ 85395-2711
(480) 849-7705
Mailing address
1360 N BULLARD AVE STE 200, GOODYEAR, AZ 85395-2744
(480) 849-7705
(623) 263-2917
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
218165
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
RN177663
AZ
Other
Enumeration date
09/26/2018
Last updated
01/14/2025
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