Provider Demographics
NPI:1871375543
Name:NUCKOLLS, MONICA (PMHNP)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:NUCKOLLS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 BRUNEAU DR APT 10
Mailing Address - Street 2:
Mailing Address - City:N SIOUX CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57049-4083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:712-234-0225
Practice Address - Street 1:600 4TH ST STE 501
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1606
Practice Address - Country:US
Practice Address - Phone:712-234-0220
Practice Address - Fax:712-234-0225
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG176713363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health