Healthcare Provider Details

I. General information

NPI: 1982587663
Provider Name (Legal Business Name): NICHOLAS NORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HUNTER CT
BOWLING GREEN KY
42103-7032
US

IV. Provider business mailing address

221 MCINTOSH DR
TAYLORSVILLE KY
40071-8404
US

V. Phone/Fax

Practice location:
  • Phone: 270-904-5104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number299447
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: