Provider Demographics
NPI:1659957876
Name:NICKEL, COURTNEY (FNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:NICKEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BAYOU OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-6700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:119 S 5TH ST
Practice Address - Street 2:
Practice Address - City:IOTA
Practice Address - State:LA
Practice Address - Zip Code:70543-6105
Practice Address - Country:US
Practice Address - Phone:337-315-0372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA218941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily