Provider Demographics
NPI:1205407319
Name:NICHOLS, DAKOTA DEAN (CRNP)
Entity Type:Individual
Prefix:
First Name:DAKOTA
Middle Name:DEAN
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-9314
Mailing Address - Country:US
Mailing Address - Phone:205-814-9284
Mailing Address - Fax:205-814-9626
Practice Address - Street 1:70 PLAZA DR
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-9314
Practice Address - Country:US
Practice Address - Phone:205-814-9284
Practice Address - Fax:205-814-9626
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-180211363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily