Provider Demographics
NPI:1881419414
Name:TAPP, NICKOLAS RYAN I
Entity type:Individual
Prefix:MR
First Name:NICKOLAS
Middle Name:RYAN
Last Name:TAPP
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 WILLIAM ST STE E
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5763
Mailing Address - Country:US
Mailing Address - Phone:573-335-3714
Mailing Address - Fax:
Practice Address - Street 1:2526 WILLIAM ST STE E
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5763
Practice Address - Country:US
Practice Address - Phone:573-335-3714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024003076237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist