Provider Demographics
NPI:1154115475
Name:NICHOLS, KRISTA (CPRS)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 BENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MALAGA
Mailing Address - State:NJ
Mailing Address - Zip Code:08328-4143
Mailing Address - Country:US
Mailing Address - Phone:856-460-0724
Mailing Address - Fax:
Practice Address - Street 1:200 HOLLY DELL DR
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9318
Practice Address - Country:US
Practice Address - Phone:856-494-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ50893175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist