Provider Demographics
NPI:1093285132
Name:NICHOLS, JAMES ALVIN (RN, MSN,BSN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALVIN
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:RN, MSN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2599 HIGHWAY 167 S
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-7117
Mailing Address - Country:US
Mailing Address - Phone:870-942-7355
Mailing Address - Fax:
Practice Address - Street 1:21 OPPORTUNITY DR
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-9185
Practice Address - Country:US
Practice Address - Phone:870-942-9833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-02
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR093306163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse