Individual
KELLY ANN NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
15758 SE HIGHWAY 224 UNIT 96, DAMASCUS, OR 97089-8410
(503) 421-8226
Mailing address
15758 SE HIGHWAY 224 UNIT 96, DAMASCUS, OR 97089-8410
(503) 421-8226
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
201142980RN
OR
Other
Enumeration date
08/07/2024
Last updated
08/07/2024
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