Healthcare Provider Details

I. General information

NPI: 1932012622
Provider Name (Legal Business Name): NICOLE KOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 STERLING DR
GEORGETOWN KY
40324-8200
US

IV. Provider business mailing address

123 STERLING DR
GEORGETOWN KY
40324-8200
US

V. Phone/Fax

Practice location:
  • Phone: 253-576-2324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number162101
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: