Provider Demographics
NPI:1356686240
Name:NICHOLS, NANCY ALCORN
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ALCORN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11650 COUNTY ROAD 4215
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75706-4646
Mailing Address - Country:US
Mailing Address - Phone:903-253-8988
Mailing Address - Fax:309-882-7571
Practice Address - Street 1:9515 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4216
Practice Address - Country:US
Practice Address - Phone:210-699-6463
Practice Address - Fax:210-694-2972
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6463103T00000X
TXLIFE CERTIFICATION172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No103T00000XBehavioral Health & Social Service ProvidersPsychologist