Provider Demographics
NPI:1083887335
Name:NICHOLSON, MELISSA GRACE (RNCPCP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GRACE
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:RNCPCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 HIGHLAND VILLAGE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7189
Mailing Address - Country:US
Mailing Address - Phone:972-317-6000
Mailing Address - Fax:972-317-6011
Practice Address - Street 1:2280 HIGHLAND VILLAGE RD STE 130
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-7189
Practice Address - Country:US
Practice Address - Phone:972-317-6000
Practice Address - Fax:972-317-6011
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX521670363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics