Individual
NICOLE K NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
10012 KENNERLY RD, SUITE 101, SAINT LOUIS, MO 63128-2197
(314) 543-5200
(314) 543-5219
Mailing address
PO BOX 23340, SAINT LOUIS, MO 63156-3340
(314) 543-5200
(314) 543-5219
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2010021406
MO
363L00000X
Nurse Practitioner
Primary
2013036540
MO
Other
Enumeration date
08/30/2013
Last updated
03/24/2016
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