Nichols, Gary Dale
Nichols, Gary Dale is an individual health care provider with primary practice located at 16Th Street Ctmc, Bldg 885, Fort Leonard Wood MO 65473. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Nichols, Gary Dale can be contacted via phone (573) 596-1680.Contact Information
Primary practice address
16Th Street Ctmc, Bldg 885
Fort Leonard Wood MO 65473
Phone: (573) 596-1680
Fax: (573) 596-0423
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA02338 | Texas |
Profile Details
| NPI number | 1437140357 |
|---|---|
| LBN Legal business name | Nichols, Gary Dale |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 31st, 2005 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1437140357 | NPPES |
| Texas | Other | PA02338 | STATE LICENSE/PERMIT |
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