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General NPI Number Information
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NPI Number | 1336197078
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Entity Type | Individual
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Provider Name | KATRINA NICKELS MD
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Gender | Female
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 800 ROSE ST
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City | LEXINGTON
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State | KY
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Zip | 40536-3229
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Country | US
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Telephone | 859-257-1000
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Fax | 859-257-1342
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Provider Business Mailing Address
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Address Line | 2312 ALEXANDRIA DR
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City | LEXINGTON
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State | KY
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Zip | 40504-3229
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Country | US
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Telephone | 859-276-5344
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Fax | 859-296-0362
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 39009
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 39009
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 39009
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License Number State | KY
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