Provider Demographics
NPI:1306800891
Name:NICHOLS, JILL E (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:E
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-901-4016
Mailing Address - Fax:512-901-3857
Practice Address - Street 1:2400 CEDAR BEND DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5378
Practice Address - Country:US
Practice Address - Phone:512-901-4016
Practice Address - Fax:512-901-3857
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3361208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105938801Medicaid
TX88G235Medicare PIN
TX8L26057Medicare PIN
TXG18947Medicare UPIN
TX105938801Medicaid