Provider Demographics
NPI:1265462782
Name:NICHOLSON, JOYNITA R (DO)
Entity Type:Individual
Prefix:
First Name:JOYNITA
Middle Name:R
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JOYNITA
Other - Middle Name:M
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:7864 RICHMOND TAPPAHANNOCK HWY
Mailing Address - Street 2:
Mailing Address - City:AYLETT
Mailing Address - State:VA
Mailing Address - Zip Code:23009-3056
Mailing Address - Country:US
Mailing Address - Phone:804-769-2015
Mailing Address - Fax:804-769-2014
Practice Address - Street 1:7864 RICHMOND TAPPAHANNOCK HWY
Practice Address - Street 2:
Practice Address - City:AYLETT
Practice Address - State:VA
Practice Address - Zip Code:23009-3056
Practice Address - Country:US
Practice Address - Phone:804-769-2015
Practice Address - Fax:804-769-2014
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA180919OtherANTHEM BCBS OF VA
VA3576236OtherCIGNA
VA760728OtherAETNA LIFE
VA010190771Medicaid
VA1153359OtherAETNA HMO
VA180919OtherANTHEM BCBS OF VA
VA3576236OtherCIGNA
VA010190771Medicaid
VA3576236OtherCIGNA
VAI11732Medicare UPIN