Individual
TAMMY R NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
2179 STATE HIGHWAY 73, MACKS CREEK, MO 65786-8228
(660) 428-5020
Mailing address
2179 STATE HIGHWAY 73, MACKS CREEK, MO 65786-8228
(660) 428-5020
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
2024041853
MO
363LF0000X
Family Nurse Practitioner
Primary
2024041853
MO
Other
Enumeration date
10/23/2024
Last updated
11/09/2024
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