Provider Demographics
NPI:1780918490
Name:NICHOLS, JANNA S (NP)
Entity type:Individual
Prefix:MS
First Name:JANNA
Middle Name:S
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JANNA
Other - Middle Name:S
Other - Last Name:KNOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5400 E. TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111
Mailing Address - Country:US
Mailing Address - Phone:318-675-1313
Mailing Address - Fax:888-965-0619
Practice Address - Street 1:5400 E. TEXAS ST
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111
Practice Address - Country:US
Practice Address - Phone:318-675-1313
Practice Address - Fax:888-965-0619
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX531115363LP2300X
LA200338363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA200338Medicaid