Provider Demographics
NPI:1669625604
Name:NICHOLSON, YASHEKA (MD)
Entity type:Individual
Prefix:DR
First Name:YASHEKA
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-3635
Mailing Address - Country:US
Mailing Address - Phone:985-795-4208
Mailing Address - Fax:985-795-4210
Practice Address - Street 1:809 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-3635
Practice Address - Country:US
Practice Address - Phone:985-795-4208
Practice Address - Fax:985-795-4210
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247286208600000X
TXN6538208C00000X
LA206908208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery