Healthcare Provider Details

I. General information

NPI: 1871404715
Provider Name (Legal Business Name): CHEYENNE NICOLE PEACE CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1974 WALTON NICHOLSON PIKE
INDEPENDENCE KY
41051-7906
US

IV. Provider business mailing address

1974 WALTON NICHOLSON PIKE
INDEPENDENCE KY
41051-7906
US

V. Phone/Fax

Practice location:
  • Phone: 502-215-3938
  • Fax:
Mailing address:
  • Phone: 502-215-3938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number50204866
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: