Individual
CRYSTAL JO NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.F.N.P.
Contact information
Practice address
285 IVIE LN, MANTACHIE, MS 38855-9764
(662) 282-4197
(662) 282-5121
Mailing address
285 IVIE LN, MANTACHIE, MS 38855-9764
(662) 282-4197
(662) 282-4197
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R870294
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05372791
—
MS
Enumeration date
10/15/2010
Last updated
10/23/2014
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