Provider Demographics
NPI:1831619501
Name:NICHOLS, JAY BRYAN (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:BRYAN
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W FIRE TOWER RD STE B
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9475
Mailing Address - Country:US
Mailing Address - Phone:252-689-6020
Mailing Address - Fax:
Practice Address - Street 1:104 W FIRE TOWER RD STE B
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-9475
Practice Address - Country:US
Practice Address - Phone:252-689-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1435237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty