Provider Demographics
NPI:1982913000
Name:NICHOLS, LETICIA ALEJANDRO (NP)
Entity Type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:ALEJANDRO
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:LETICIA
Other - Middle Name:
Other - Last Name:ALEJANDRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2201 S STERLING ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4044
Mailing Address - Country:US
Mailing Address - Phone:828-580-5380
Mailing Address - Fax:828-580-5389
Practice Address - Street 1:117 FOOTHILLS DRIVE
Practice Address - Street 2:BUILDING D
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4044
Practice Address - Country:US
Practice Address - Phone:828-580-5380
Practice Address - Fax:828-580-5838
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC212381363LA2200X, 363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5003641OtherNP APPROVAL NUMBER
NC5003641OtherNP APPROVAL NUMBER