Provider Demographics
NPI:1508610148
Name:TROGDON, NICKOLAS CHARLES (FNP)
Entity Type:Individual
Prefix:
First Name:NICKOLAS
Middle Name:CHARLES
Last Name:TROGDON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 PYRAMID DR APT 621
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-3269
Mailing Address - Country:US
Mailing Address - Phone:304-688-2020
Mailing Address - Fax:
Practice Address - Street 1:2718 W ROSCOE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5910
Practice Address - Country:US
Practice Address - Phone:773-961-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV108418363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care