Provider Demographics
NPI:1144283664
Name:NICHOLS, ALAN (FNP)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2435
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:TX
Mailing Address - Zip Code:76430-8020
Mailing Address - Country:US
Mailing Address - Phone:325-762-2447
Mailing Address - Fax:325-893-4035
Practice Address - Street 1:217 EDWARDS
Practice Address - Street 2:
Practice Address - City:MERKEL
Practice Address - State:TX
Practice Address - Zip Code:79536-3803
Practice Address - Country:US
Practice Address - Phone:325-928-0014
Practice Address - Fax:325-893-4035
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX684692363L00000X
TXAP113748363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173806404Medicaid