Healthcare Provider Details

I. General information

NPI: 1881527323
Provider Name (Legal Business Name): MADISON NICOLE KACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MARKET PLACE CIR
GEORGETOWN KY
40324-7400
US

IV. Provider business mailing address

90 KINGSTON XING APT 2107
BOSSIER CITY LA
71111-6293
US

V. Phone/Fax

Practice location:
  • Phone: 502-863-4807
  • Fax:
Mailing address:
  • Phone: 214-425-1528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number227170
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: