Healthcare Provider Details

I. General information

NPI: 1306716980
Provider Name (Legal Business Name): NICHOLAS KENT BADER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 NORTHFORK DR
CHILLICOTHEE OH
45601-1016
US

IV. Provider business mailing address

18 NORTHFORK DR
CHILLICOTHEE OH
45601-1016
US

V. Phone/Fax

Practice location:
  • Phone: 740-466-5542
  • Fax:
Mailing address:
  • Phone: 740-466-5542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberRN651646
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: