Provider Demographics
NPI:1639859945
Name:NICHOLS, KELLY ANN (CLD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BLACKBERRY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-6702
Mailing Address - Country:US
Mailing Address - Phone:706-604-2560
Mailing Address - Fax:
Practice Address - Street 1:12 BLACKBERRY VALLEY RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-6702
Practice Address - Country:US
Practice Address - Phone:706-604-2560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula