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Jenna St. Nicholas, PTA — NPI 1053891002, Kilgore, TX | NPI Central

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NPI 1053891002

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Jenna St. Nicholas, PTA

NPI 1053891002 · Physical Therapy Assistant · Kilgore, TX

Provider details

NPI number: 1053891002
Entity type: Individual
Primary specialty: Physical Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Credential: PTA
Sex: Female
Sole proprietor: Yes
License: 2090656 (TX)

Specialties & taxonomies

Physical Therapy AssistantPrimary225200000XLicense 2090656 (TX)
Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Practice location

1100 Broadway Blvd

Kilgore, TX 75662-3204

Phone: (903) 983-8209

Approximate (ZIP-level) locationGet directions

More TX providers

Mailing address

1100 Broadway Blvd

Kilgore, TX 75662-3204

Additional practice locations (1)

2131 Alpine Rd
Longview, TX 75601-3402
Phone: (903) 757-8786

Registry dates

Enumerated: 2018-08-20
Last updated: 2018-08-20

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.