Healthcare Provider Details

I. General information

NPI: 1932136041
Provider Name (Legal Business Name): ROBERT BAIRD NICKERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 SOUTH LIMESTONE
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

138 LEADER AVE
LEXINGTON KY
40508-3215
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-4888
  • Fax:
Mailing address:
  • Phone: 859-257-7910
  • Fax: 859-257-7899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number27572
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: