Provider Demographics
NPI:1619335684
Name:NICHOLS, DARLENE (RD)
Entity type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:RD
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 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-286-0800
Mailing Address - Fax:314-286-0855
Practice Address - Street 1:4205 FOREST PARK AVE
Practice Address - Street 2:DIV IM NEPHROLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2810
Practice Address - Country:US
Practice Address - Phone:314-286-0800
Practice Address - Fax:314-286-0855
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001012154133V00000X, 133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered