Individual
MATTHEW NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 401-5555
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 401-5555
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101276534
VA
208600000X
Surgery Physician
0101276534
VA
208D00000X
General Practice Physician
0101276534
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/08/2019
Last updated
08/06/2025
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