Basic Information
| Provider Information | |||||||||
| NPI: | 1205407319 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICHOLS | ||||||||
| FirstName: | DAKOTA | ||||||||
| MiddleName: | DEAN | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | PELL CITY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351259314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058149284 | ||||||||
| FaxNumber: | 2058149626 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | PELL CITY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351259314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058149284 | ||||||||
| FaxNumber: | 2058149626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2021 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1-180211 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.