| Doctor Name: | MR. EDWARD CLAY NICHOLS |
| NPI Number: | 1063745602 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | APO5939 |
| Business Practice Address: | 3326 Front St Winnsboro, LA - 712956487 |
| Business Phone Number: | 3184357333 |
| Business Fax Number: | 3184359061 |
| Mailing Address: | 2375 Highway 130, WINNSBORO |
| State: | LA |
| Postal Code: | 712957704 |
| Phone Number: | 3184354064 |
| Fax Number: | |
| NPI Enumeration Date: | 09/15/2009 |
| NPI Last Update Date: | 09/15/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | APO5939 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |