Provider Demographics
NPI:1194295170
Name:ATKINSON, NICHOLAS ALEXANDER (AGPCNP)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ALEXANDER
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 WAILEA IKE PL APT 14
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-9565
Mailing Address - Country:US
Mailing Address - Phone:678-939-2209
Mailing Address - Fax:
Practice Address - Street 1:472 KAULANA ST
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2050
Practice Address - Country:US
Practice Address - Phone:808-877-2761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN282157163WR0400X
HI92269163WR0400X
HI2603363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation