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General NPI Number Information
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NPI Number | 1518049030
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Entity Type | Organization
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Legal Business Name | NORTHERN KENTUCKY FOOT SPECIALISTS, PSC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 02/04/2014
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Provider Practice Location Address
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Address Line | 4327 WINSTON AVE
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City | COVINGTON
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State | KY
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Zip | 41015-1739
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Country | US
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Telephone | 859-261-8608
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Fax | 859-261-9292
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Provider Business Mailing Address
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Address Line | PO BOX 389
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City | BURLINGTON
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State | KY
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Zip | 41005-0389
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Country | US
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Telephone | 859-746-7461
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Fax | 859-746-7464
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM M NIELSON
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Credential | DPM
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Telephone | 859-746-7461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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