Healthcare Provider Details

I. General information

NPI: 1265341002
Provider Name (Legal Business Name): NICOLE LEVY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N 19TH ST
MIDDLESBORO KY
40965-2865
US

IV. Provider business mailing address

239 PINE MOUNTAIN ESTATE RD
PINEVILLE KY
40977-7556
US

V. Phone/Fax

Practice location:
  • Phone: 606-269-1475
  • Fax:
Mailing address:
  • Phone: 606-269-1475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: