Individual
MR. GARY DALE NICHOLS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
16TH STREET, CTMC, BLDG 885, FORT LEONARD WOOD, MO 65473
(573) 596-1680
(573) 596-0423
Mailing address
191 PRIVATE ROAD 845, TEAGUE, TX 75860-6081
(254) 625-0310
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02338
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA02338
STATE LICENSE/PERMIT
TX
Enumeration date
10/31/2005
Last updated
07/08/2007
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us