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General NPI Number Information
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NPI Number | 1538884432
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Entity Type | Individual
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Provider Name | KEVIN NICKENS FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 206 CEDAR LN
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City | KNOXVILLE
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State | TN
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Zip | 37912-3507
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Country | US
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Telephone | 865-666-3640
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Fax | 865-666-3641
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Provider Business Mailing Address
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Address Line | 5201 WESTERN AVE APT 515
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City | KNOXVILLE
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State | TN
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Zip | 37921-4195
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Country | US
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Telephone | 865-232-8017
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 32232
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License Number State | TN
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