Gary Dale Nichols, P.A.-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA02338 Issued in TX

Practice address

16TH Street
CTMC, BLDG 885
Fort Leonard Wood, MO 65473

Phone

(573) 596-1680

Fax

(573) 596-0423

NPI assigned

Oct 31, 2005

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1437140357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 PRIVATE ROAD 845",
            "city": "TEAGUE",
            "state": "TX",
            "postal_code": "758606081",
            "telephone_number": "254-625-0310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16TH STREET",
            "address_2": "CTMC, BLDG 885",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "65473",
            "telephone_number": "573-596-1680",
            "fax_number": "573-596-0423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "GARY",
        "middle_name": "DALE",
        "name_prefix": "Mr.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA02338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE/PERMIT",
            "identifier": "PA02338",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jazmyne Kaye Myran
• Ashley Nicholle Myres
• Matthew Scott Neal, DPT
• April Marie Nelson, RDH
• Brian Thomas Nelson
• Kiana Michele Norris, RD
• Mona Novakoski
• Meghan Nicole O'Connor
• Ryan Matthew O'Keefe, MD
• Ifesonye Emiloju Okwuchi, NP

• Physician Assistant in Fort Leonard Wood, MO
• Providers in Fort Leonard Wood, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.