Individual
JILL NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
5003 HARDY ST, HATTIESBURG, MS 39402-1319
(601) 296-3530
Mailing address
391 SANDHILL RD, ELLISVILLE, MS 39437-8423
(601) 325-4765
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R881571
MS
Other
Enumeration date
07/28/2016
Last updated
04/28/2017
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