Provider Demographics
NPI:1275257529
Name:MCALLISTER, NICKOLAS RESHAY
Entity Type:Individual
Prefix:
First Name:NICKOLAS
Middle Name:RESHAY
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NICKOLAS
Other - Middle Name:RESHAY
Other - Last Name:FOLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:340 LANGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:EVERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76140-4504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 LANGLEY AVE
Practice Address - Street 2:
Practice Address - City:EVERMAN
Practice Address - State:TX
Practice Address - Zip Code:76140-4504
Practice Address - Country:US
Practice Address - Phone:850-982-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX509767G343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)