Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Nathan Vicknair, STUDENT

Individual provider Gastroenterology Physician · NPI 1376171298

Dr. Nathan Vicknair, STUDENT is a Gastroenterology Physician in Pueblo, Colorado. Licensed in Louisiana. Registered with an NPI since 2020.

Licensed in
LA
In the registry since
2020
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Practice location Address checks out

400 W 16th St
Pueblo, CO 81003-2745
Phone: (719) 584-4000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Gastroenterology Physician (primary) Taxonomy 207RG0100X · Licence 352219 (LA)

Record details

NPI number1376171298
Entity typeIndividual (Type 1)
GenderMale
Credentials STUDENT
Sole proprietorNo
NPI enumeratedMarch 27, 2020
Last updated in NPPESAugust 6, 2026
Certification dateAugust 6, 2026

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