Healthcare Provider Details

I. General information

NPI: 1831796416
Provider Name (Legal Business Name): NICOLE SCHMIDT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 S 6TH ST
MAYFIELD KY
42066-2311
US

IV. Provider business mailing address

417 S 6TH ST
MAYFIELD KY
42066-2311
US

V. Phone/Fax

Practice location:
  • Phone: 270-247-1104
  • Fax: 270-251-4049
Mailing address:
  • Phone: 270-247-1104
  • Fax: 270-247-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3014636
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number3014636
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: