Individual
ALICIA FAULK NICKLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
104 GENEVIEVE DR, LAFAYETTE, LA 70503-4811
(337) 984-0110
(337) 981-7210
Mailing address
104 GENEVIEVE DR, LAFAYETTE, LA 70503-4811
(337) 984-0110
(337) 981-7210
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
AP09172
LA
Other
Enumeration date
04/18/2017
Last updated
09/26/2018
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