Provider Demographics
NPI:1972209153
Name:NICHOLAS, MARCEY (CRNP)
Entity type:Individual
Prefix:
First Name:MARCEY
Middle Name:
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S WOODBURN DR STE 2
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1109
Mailing Address - Country:US
Mailing Address - Phone:334-649-3458
Mailing Address - Fax:949-703-7298
Practice Address - Street 1:105 S WOODBURN DR STE 2
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1109
Practice Address - Country:US
Practice Address - Phone:334-649-3458
Practice Address - Fax:949-703-7298
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-127093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily