Provider Demographics
NPI:1790179521
Name:EHINGER, NICOLE RENEE (FNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:EHINGER
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:PO BOX 1308
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63902-1308
Mailing Address - Country:US
Mailing Address - Phone:573-843-8380
Mailing Address - Fax:573-843-8381
Practice Address - Street 1:2651 SHELBY RD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2387
Practice Address - Country:US
Practice Address - Phone:573-843-8380
Practice Address - Fax:573-843-8381
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015008446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily