Provider Demographics
NPI:1710564976
Name:NICKLES, JESSICA MCLEAN (DO, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MCLEAN
Last Name:NICKLES
Suffix:
Gender:F
Credentials:DO, PHARMD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LAURA
Other - Last Name:MCLEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2000 PEPPERELL PKWY
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5452
Mailing Address - Country:US
Mailing Address - Phone:334-364-3300
Mailing Address - Fax:334-364-3301
Practice Address - Street 1:2000 PEPPERELL PKWY
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5452
Practice Address - Country:US
Practice Address - Phone:334-364-3300
Practice Address - Fax:334-364-3301
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16283183500000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No183500000XPharmacy Service ProvidersPharmacist