Provider Demographics
NPI:1396291142
Name:NICHOLS, CONNOR
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 534
Mailing Address - Street 2:
Mailing Address - City:BATSON
Mailing Address - State:TX
Mailing Address - Zip Code:77519-0534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12609 BATSON PRAIRE LOOP ROAD
Practice Address - Street 2:
Practice Address - City:BATSON
Practice Address - State:TX
Practice Address - Zip Code:77519-0534
Practice Address - Country:US
Practice Address - Phone:936-346-1564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program