Individual
JASON S NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
301 MED TECH PKWY STE 120, JOHNSON CITY, TN 37604-2364
(423) 794-5590
(423) 794-5877
Mailing address
PO BOX 632476, CINCINNATI, OH 45263-2476
(423) 794-5590
(423) 794-5877
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
21978
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q026470
—
TN
Enumeration date
10/30/2016
Last updated
02/20/2025
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