Healthcare Provider Details

I. General information

NPI: 1295684934
Provider Name (Legal Business Name): NICOLE D. HUCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE D. SMITH

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W 4TH AVE
KENNEWICK WA
99336-5533
US

IV. Provider business mailing address

1515 S JEFFERSON PL
KENNEWICK WA
99338-2182
US

V. Phone/Fax

Practice location:
  • Phone: 509-222-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60355209
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: