Healthcare Provider Details

I. General information

NPI: 1528640364
Provider Name (Legal Business Name): NICOLE MCNEES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8780 US HIGHWAY 42
FLORENCE KY
41042-6936
US

IV. Provider business mailing address

1720 KY HIGHWAY 1743
CYNTHIANA KY
41031-4890
US

V. Phone/Fax

Practice location:
  • Phone: 859-292-0123
  • Fax:
Mailing address:
  • Phone: 859-298-8951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3015922
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: