Provider Demographics
NPI:1821313412
Name:NICHOLS, JESSIE LOU (L AC)
Entity Type:Individual
Prefix:MS
First Name:JESSIE
Middle Name:LOU
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:MRS
Other - First Name:JESSIE
Other - Middle Name:LOU
Other - Last Name:NICHOLS-BARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 DOWNS AVE.
Mailing Address - Street 2:ACUPUNCTURE ALTERNATIVE MEDICINE
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078
Mailing Address - Country:US
Mailing Address - Phone:937-508-4245
Mailing Address - Fax:937-508-4246
Practice Address - Street 1:130 DOWNS AVE.
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078
Practice Address - Country:US
Practice Address - Phone:937-508-4245
Practice Address - Fax:937-508-4246
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000181171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist