Individual
KATHLEEN NICKOLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
901 HUGH WALLIS RD S, LAFAYETTE, LA 70508-2511
(866) 542-4768
Mailing address
66 RABBIT TRL, BERKELEY SPRINGS, WV 25411-6449
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
108437
WV
Other
Enumeration date
09/04/2023
Last updated
09/04/2023
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