Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | L8866 | TX |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | L8866 | TX |
NPI | 1548211634 |
---|---|
Provider Name | Dr. Dominique A Nickson |
First Address | Mckinney, TX 75070-6506 |
Second Address | Mckinney, TX 75070-6506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 29/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2454999 | UNITED HEALTHCARE (01) | |
285510801 | (05) | TX |
6512550001 | DME PTAN (01) | TX |
BN8795570 | DEA (01) | |
L8866 | LICENSE (01) | TX |
P00658084 | RAILROAD MEDICARE (01) | |
P01047820 | RAILROAD MEDICARE PTAN (01) | TX |
TXB128126 | MEDICARE PTAN (01) | TX |