Provider Demographics
NPI:1316930050
Name:ATKINSON, NIALL RICHARD (FNP)
Entity type:Individual
Prefix:MR
First Name:NIALL
Middle Name:RICHARD
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 HOLLENBECK LN
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59722-2317
Mailing Address - Country:US
Mailing Address - Phone:406-846-2212
Mailing Address - Fax:
Practice Address - Street 1:198 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2323
Practice Address - Country:US
Practice Address - Phone:317-736-7211
Practice Address - Fax:317-736-6742
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-100819207P00000X
IN71001455A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INQ15635Medicare UPIN