Provider Demographics
NPI:1861943268
Name:NICHOLS, BONNIE SUE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:SUE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:FNP-C
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 848476
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8476
Mailing Address - Country:US
Mailing Address - Phone:254-202-9330
Mailing Address - Fax:254-202-9349
Practice Address - Street 1:7702 CENTRAL PARK DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6535
Practice Address - Country:US
Practice Address - Phone:254-202-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily