Provider Demographics
NPI:1841683844
Name:NICHOLS, KRISTI REBECCA (FNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:REBECCA
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30549 SUSSEX HWY
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-3891
Mailing Address - Country:US
Mailing Address - Phone:302-715-5214
Mailing Address - Fax:
Practice Address - Street 1:30549 SUSSEX HWY
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-3891
Practice Address - Country:US
Practice Address - Phone:302-715-5214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-15
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily