Provider Demographics
NPI:1073564050
Name:NICHOLS, CYNTHIA H (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:H
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-2240
Mailing Address - Country:US
Mailing Address - Phone:662-429-5221
Mailing Address - Fax:662-429-7917
Practice Address - Street 1:124 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2240
Practice Address - Country:US
Practice Address - Phone:662-429-5221
Practice Address - Fax:662-429-7917
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR707295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09979281Medicaid
MS5000001317Medicare ID - Type Unspecified
MS09979281Medicaid