Provider Demographics
NPI:1982995940
Name:NICHOLS, JEANINE L (CRNA)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:L
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JEANINE
Other - Middle Name:
Other - Last Name:CHARTRAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2115 TWIN OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-2152
Mailing Address - Country:US
Mailing Address - Phone:832-600-9703
Mailing Address - Fax:
Practice Address - Street 1:2201 CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4110
Practice Address - Country:US
Practice Address - Phone:254-526-7523
Practice Address - Fax:254-724-8572
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX822385367500000X
TXAP122211367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered