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Individual

KELLY L NICKELSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHYSICAL THERAPIST

Contact information

Practice address
401 GAYLORD DR, FULTON, MO 65251-2517
(573) 642-8541
(573) 642-8500
Mailing address
401 GAYLORD DR, FULTON, MO 65251-2517
(573) 642-8541
(573) 642-8500

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
2002015010
MO
225100000X
Physical Therapist
Primary
2002015010
MO

Other

Enumeration date
10/01/2007
Last updated
04/19/2023
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