Provider Demographics
NPI:1871500223
Name:MCNICHOLAS-HENDRIX, COLLEEN (NP)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:MCNICHOLAS-HENDRIX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:HENDRIX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:400 SW 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-8246
Mailing Address - Country:US
Mailing Address - Phone:940-745-0484
Mailing Address - Fax:940-328-6260
Practice Address - Street 1:400 SW 25TH AVE
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-8246
Practice Address - Country:US
Practice Address - Phone:940-745-0484
Practice Address - Fax:940-328-6260
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251206207P00000X
TXAP105255363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147183106Medicaid