Healthcare Provider Details

I. General information

NPI: 1013890029
Provider Name (Legal Business Name): NICOLE HERBEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICKY HERBEL NP

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 MATTOX DR
SULLIVAN MO
63080-2365
US

IV. Provider business mailing address

2106 COUNTY LINE RD
ROSEBUD MO
63091-1900
US

V. Phone/Fax

Practice location:
  • Phone: 573-860-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2025045575
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2019038523
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: