Healthcare Provider Details

I. General information

NPI: 1063895522
Provider Name (Legal Business Name): NICOLE ABBOT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE ABBOT MD

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MAN O WAR BLVD
UNION KY
41091-2017
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-757-0717
  • Fax: 859-331-2425
Mailing address:
  • Phone: 859-301-5901
  • Fax: 859-301-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number53296
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number53296
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125066456
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: