Provider Demographics
NPI:1730952821
Name:NICHOLSON, RACHAEL LYNN (FNP)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LYNN
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 WORLEY RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-3589
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:573-756-1959
Practice Address - Street 1:715 MAPLE VALLEY DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1944
Practice Address - Country:US
Practice Address - Phone:573-756-5298
Practice Address - Fax:573-756-1959
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023044095363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily