Provider Demographics
NPI:1780085480
Name:NICHOLS, REGINALD SCOTT (FNP)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:SCOTT
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 1:116 JUNCO LN
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-9824
Mailing Address - Country:US
Mailing Address - Phone:828-556-9134
Mailing Address - Fax:
Practice Address - Street 1:571 S ALLEN RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731
Practice Address - Country:US
Practice Address - Phone:828-692-6178
Practice Address - Fax:828-356-3996
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007158363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5007158OtherNURSE PRACTITIONER
NC1780085480Medicaid
NC247416OtherRN
NCMN3301203OtherDEA