Individual
JOHN RYAN NUCKOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNP CRNA
Contact information
Practice address
6020 PORTICO DR APT 1527, FORT WORTH, TX 76132-4189
(806) 282-6439
Mailing address
6020 PORTICO DR APT 1527, FORT WORTH, TX 76132-4189
(806) 282-6439
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
103227
TX
Other
Enumeration date
12/21/2015
Last updated
12/21/2015
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