Provider Demographics
NPI:1982205456
Name:STINSON, NICOLE VICKERY (CRNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:VICKERY
Last Name:STINSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:NICOLE
Other - Last Name:VICKERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 GREENBRIER WOOD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-4374
Mailing Address - Country:US
Mailing Address - Phone:256-679-3360
Mailing Address - Fax:
Practice Address - Street 1:2006 FRANKLIN ST SE STE 202A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4537
Practice Address - Country:US
Practice Address - Phone:256-489-0976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-145775363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care