=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528640364
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE MCNEES APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2021
-----------------------------------------------------
Last Update Date | 04/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8780 US HIGHWAY 42
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41042-6936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-292-0123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1720 KY HIGHWAY 1743
-----------------------------------------------------
City | CYNTHIANA
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41031-4890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-298-8951
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 3015922
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------