Individual
NICHOLAS KRISHNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1103 16TH AVE SE, DECATUR, AL 35601-3595
(256) 350-0362
(256) 355-9779
Mailing address
1103 16TH AVE SE, DECATUR, AL 35601-3595
(256) 350-0362
(256) 355-9779
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1045
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
170557
—
AL
01
—
51160179
BLUE CROSS BLUE SHIELD OF ALABAMA
AL
01
—
PA.1045
ALABAMA PA LICENSE
AL
Enumeration date
03/19/2015
Last updated
05/16/2015
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