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General NPI Number Information
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NPI Number | 1063195436
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Entity Type | Individual
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Provider Name | NICOLE PRYOR LMT
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Gender | Female
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Dates
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Enumeration Date | 08/10/2023
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 2716 OLD ROSEBUD RD STE 230
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City | LEXINGTON
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State | KY
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Zip | 40509-8003
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Country | US
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Telephone | 859-263-8833
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Fax |
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Provider Business Mailing Address
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Address Line | 111 RIVER RUN CT
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City | GEORGETOWN
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State | KY
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Zip | 40324-8444
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Country | US
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Telephone | 859-904-3134
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 104962
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License Number State | KY
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