Healthcare Provider Details

I. General information

NPI: 1497893085
Provider Name (Legal Business Name): NICHOL B. BURCHFIELD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17401 KY HIGHWAY 80 E
ELKHORN CITY KY
41522-8226
US

IV. Provider business mailing address

PO BOX 2122
PIKEVILLE KY
41502-2122
US

V. Phone/Fax

Practice location:
  • Phone: 606-754-7100
  • Fax: 606-754-0770
Mailing address:
  • Phone: 606-422-4764
  • Fax: 606-754-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA559
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: