Individual
DR. STACEY ANNA NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5500 E KELLOGG DR, WICHITA, KS 67218-1607
(316) 259-0560
Mailing address
5500 E KELLOGG DR, WICHITA, KS 67218-1607
(316) 259-0560
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0432131
KS
Other
Enumeration date
05/01/2007
Last updated
01/09/2014
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