Individual
MISTY-LYNN NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPT
Contact information
Practice address
3011 WHISPERING PINE BLVD, MELISSA, TX 75454
(585) 749-0077
Mailing address
3011 WHISPERING PINE BLVD, MELISSA, TX 75454-2653
(585) 749-0077
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
CPTE161215-171347
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CPTE161215-171347
CPT
TX
Enumeration date
06/08/2017
Last updated
07/21/2022
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