| Michael A. Nicholas Phd Pllc | |
|
100 Fountain Ave Suite 220 Paducah KY 42001-2771 | |
| (270) 408-4192 | |
| Not Available |
| Full Name | Michael A. Nicholas Phd Pllc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 100 Fountain Ave, Paducah, Kentucky |
| Authorized Official Name and Position | Raychal D Walker (OFFICE MANAGER) |
| Authorized Official Contact | 2704084192 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael A. Nicholas Phd Pllc Po Box 7723 Paducah KY 42002-7723 Ph: (270) 408-4192 | Michael A. Nicholas Phd Pllc 100 Fountain Ave Suite 220 Paducah KY 42001-2771 Ph: (270) 408-4192 |
| NPI Number | 1932378270 |
|---|---|
| Provider Enumeration Date | 02/20/2008 |
| Last Update Date | 06/05/2008 |
| Medicare PECOS PAC ID | 4789763384 |
|---|---|
| Medicare Enrollment ID | O20080909000739 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932378270 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 850 (Kentucky) | Primary |
| Provider Name | Michael A Nicholas |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467471565 PECOS PAC ID: 5698854289 Enrollment ID: I20080909000736 |
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