Healthcare Provider Details

I. General information

NPI: 1104594423
Provider Name (Legal Business Name): ENGLISH NICHOLE GOLDSBOROUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 ENVOY CIR STE 1302
LOUISVILLE KY
40299-2894
US

IV. Provider business mailing address

2303 QUINN DR
LOUISVILLE KY
40216-2940
US

V. Phone/Fax

Practice location:
  • Phone: 502-630-2006
  • Fax:
Mailing address:
  • Phone: 502-751-1435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: