Provider Demographics
NPI:1043837362
Name:MCNICHOL, KERON ANDRE (RN)
Entity Type:Individual
Prefix:
First Name:KERON
Middle Name:ANDRE
Last Name:MCNICHOL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 HICKMAN ST APT A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-1843
Mailing Address - Country:US
Mailing Address - Phone:915-704-2683
Mailing Address - Fax:
Practice Address - Street 1:14213 GIL REYES DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2710
Practice Address - Country:US
Practice Address - Phone:915-704-2683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX955774163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health