Healthcare Provider Details

I. General information

NPI: 1396938999
Provider Name (Legal Business Name): NICOLE L. WEBER-KULWICKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE L. WEBER NP

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 WINCHESTER AVE
ASHLAND KY
41101-7848
US

IV. Provider business mailing address

PO BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-2600
  • Fax: 606-408-2603
Mailing address:
  • Phone: 606-408-2600
  • Fax: 606-408-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number127235
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number127235-030
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3006307
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: