Provider Demographics
NPI:1609185255
Name:NICHOLSON, YOLANDA MCCLAM (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:MCCLAM
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:RENEE
Other - Last Name:MCCLAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:STE. 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7008
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:112 N BENBOW ROAD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27411-7299
Practice Address - Country:US
Practice Address - Phone:336-285-2906
Practice Address - Fax:336-256-2613
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004898363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2595054OtherPTAN MEDICARE