Provider Demographics
NPI:1225002215
Name:NICHOLSON, KRISTIN DAWN (MS, ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:DAWN
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12349 METRIC BLVD
Mailing Address - Street 2:APARTMENT 812
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2585
Mailing Address - Country:US
Mailing Address - Phone:512-968-6711
Mailing Address - Fax:512-439-1944
Practice Address - Street 1:4700 SETON CENTER PKWY
Practice Address - Street 2:SUITE 175
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5295
Practice Address - Country:US
Practice Address - Phone:512-439-1940
Practice Address - Fax:512-439-1944
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer