Provider Demographics
NPI:1427814987
Name:GEARHART, NICHOLAS NELSON (LVN)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:NELSON
Last Name:GEARHART
Suffix:
Gender:M
Credentials:LVN
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 1442
Mailing Address - Street 2:
Mailing Address - City:KOUNTZE
Mailing Address - State:TX
Mailing Address - Zip Code:77625-1442
Mailing Address - Country:US
Mailing Address - Phone:409-782-0473
Mailing Address - Fax:
Practice Address - Street 1:604 FM 1293 RD
Practice Address - Street 2:
Practice Address - City:KOUNTZE
Practice Address - State:TX
Practice Address - Zip Code:77625-7804
Practice Address - Country:US
Practice Address - Phone:409-246-3481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10002822164W00000X
TX1025139164X00000X
NV862362164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse