Healthcare Provider Details

I. General information

NPI: 1295356806
Provider Name (Legal Business Name): NICHOLAS BRINKMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7766 EWING BLVD
FLORENCE KY
41042-7537
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-371-1153
  • Fax: 859-647-5113
Mailing address:
  • Phone: 859-344-5555
  • Fax: 859-344-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number62016
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: