Individual
NICOLE MATTHS HARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5326 O'DOVAN DRIVE, BATON ROUGE, LA 70808
(512) 615-3280
Mailing address
5326 O'DONOVAN DRIVE, BATON ROUGE, LA 70808
(225) 769-7546
(225) 769-0471
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD-202933
LA
207N00000X
Dermatology Physician
P2489
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1096199
—
LA
01
—
8DE581
BCBS
TX
Enumeration date
06/10/2008
Last updated
09/15/2014
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