Individual
DR. DOMINIQUE A NICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8876 SYNERGY DR, SUITE 100, MCKINNEY, TX 75070-1276
(972) 547-0047
(877) 400-6329
Mailing address
8876 SYNERGY DR STE 100, MCKINNEY, TX 75070-1276
(972) 547-0047
(877) 400-6329
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
L8866
TX
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
L8866
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2454999
UNITED HEALTHCARE
—
05
—
285510801
—
TX
01
—
6512550001
DME PTAN
TX
01
—
L8866
LICENSE
TX
01
—
P00658084
RAILROAD MEDICARE
—
01
—
P01047820
RAILROAD MEDICARE PTAN
TX
01
—
TXB128126
MEDICARE PTAN
TX
Enumeration date
05/13/2006
Last updated
06/07/2024
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