Individual
LARRY C NICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2706 MEDICAL OFFICE PLACE, GOLDSBORO, NC 27534-9460
(919) 734-4736
(919) 580-1017
Mailing address
2706 MEDICAL OFFICE PLACE, GOLDSBORO, NC 27534-9460
(919) 734-4736
(919) 580-1017
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
27762
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28723
MEDCOST
—
01
—
62640
BCBS
—
Enumeration date
11/16/2006
Last updated
06/14/2011
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