Provider Demographics
NPI:1871584540
Name:NICHOLSON, KARIN LARISSA (MD)
Entity type:Individual
Prefix:DR
First Name:KARIN
Middle Name:LARISSA
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1105 WAIMEA BND
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2379
Mailing Address - Country:US
Mailing Address - Phone:254-288-8921
Mailing Address - Fax:254-288-8712
Practice Address - Street 1:36000 DARNALL LOOP
Practice Address - Street 2:MCHE-QD (CREDS)
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5095
Practice Address - Country:US
Practice Address - Phone:254-288-8921
Practice Address - Fax:254-288-8712
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01056268A207RC0200X, 207RS0012X, 207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine