Provider Demographics
NPI:1780042887
Name:NICHOLS, JAMES K JR (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:K
Last Name:NICHOLS
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 COLEMAN DR
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-1766
Mailing Address - Country:US
Mailing Address - Phone:334-606-4864
Mailing Address - Fax:
Practice Address - Street 1:101 COLEMAN DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-1766
Practice Address - Country:US
Practice Address - Phone:334-606-4864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-127099367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered