Provider Demographics
NPI:1336864057
Name:NICKOLSON, KATRINA LAVETTE (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:LAVETTE
Last Name:NICKOLSON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2001 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2338
Mailing Address - Country:US
Mailing Address - Phone:903-577-6000
Mailing Address - Fax:
Practice Address - Street 1:801 HIGHWAY 37 S
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:TX
Practice Address - Zip Code:75457-4501
Practice Address - Country:US
Practice Address - Phone:903-577-2273
Practice Address - Fax:903-434-7094
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP1095795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily