Provider Demographics
NPI:1871263590
Name:NICKENS, MARYE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARYE
Middle Name:
Last Name:NICKENS
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 1:4808 FAIRMONT PKWY # 207
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3722
Mailing Address - Country:US
Mailing Address - Phone:832-455-1615
Mailing Address - Fax:
Practice Address - Street 1:163 S 9TH ST
Practice Address - Street 2:
Practice Address - City:SLATON
Practice Address - State:TX
Practice Address - Zip Code:79364-4121
Practice Address - Country:US
Practice Address - Phone:806-828-1600
Practice Address - Fax:806-828-1610
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1054511363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily