Provider Demographics
NPI:1164658142
Name:NICHOLS, LELIA LAGRASSE (NP)
Entity Type:Individual
Prefix:
First Name:LELIA
Middle Name:LAGRASSE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 N CENTRAL EXPY STE 160
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5951
Mailing Address - Country:US
Mailing Address - Phone:214-265-1818
Mailing Address - Fax:214-265-1806
Practice Address - Street 1:9101 N CENTRAL EXPY STE 160
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5951
Practice Address - Country:US
Practice Address - Phone:214-265-1818
Practice Address - Fax:214-265-1806
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP117988363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L16124Medicare PIN
TX8L16118Medicare PIN
TX203810102Medicaid
TX203810101Medicaid
TX8L16123Medicare PIN