Provider Demographics
NPI:1770685711
Name:RICCIONI, NICOLE KNOX (RN, CPNP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:KNOX
Last Name:RICCIONI
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:KNOX-BIMLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CPNP
Mailing Address - Street 1:6621 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2358
Mailing Address - Country:US
Mailing Address - Phone:832-826-5334
Mailing Address - Fax:
Practice Address - Street 1:6621 FANNIN ST
Practice Address - Street 2:WT6-006
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2303
Practice Address - Country:US
Practice Address - Phone:832-826-5334
Practice Address - Fax:832-825-5241
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX663122363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics