Individual
MRS. KRISTY LEIGH NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
301 MEDICAL AVE STE C, ANDALUSIA, AL 36420-1105
(334) 222-2073
Mailing address
PO BOX 1720, ANDALUSIA, AL 36420-1229
(334) 222-2073
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-073811
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
237989
—
AL
01
—
510-09630
BLUE CROSS BLUE SHIELD OF ALABAMA
AL
Enumeration date
09/29/2008
Last updated
09/28/2021
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