Individual
AMY L NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1650 W NORTHWEST HWY STE 200, GRAPEVINE, TX 76051-8122
(972) 716-3922
(214) 948-5516
Mailing address
3139 SOUTHLAKE PARK RD, SOUTHLAKE, TX 76092-2501
(214) 668-6575
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA03950
TX
Other
Enumeration date
09/22/2005
Last updated
08/26/2020
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