Individual
KATIE ELIZABETH NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4400 E FLAMINGO AVE STE 200, NAMPA, ID 83687-9203
(208) 302-2700
(208) 367-2725
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA-1889
ID
363AS0400X
Surgical Physician Assistant
PA9112309
FL
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103724800
—
FL
Enumeration date
06/26/2019
Last updated
09/12/2023
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