Provider Demographics
NPI:1326596966
Name:NICHOLS, MISTY M (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:M
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:740-845-7700
Mailing Address - Fax:740-845-7701
Practice Address - Street 1:210 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1115
Practice Address - Country:US
Practice Address - Phone:740-845-7000
Practice Address - Fax:740-845-7701
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRNCNP019864363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner