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General NPI Number Information
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NPI Number | 1679886162
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Entity Type | Individual
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Provider Name | KELLY S NICOL RN
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Gender | Female
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 17273 STATE ROUTE 104
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-9718
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Country | US
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Telephone | 740-773-1141
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Fax |
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Provider Business Mailing Address
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Address Line | 17273 STATE ROUTE 104
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-9718
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Country | US
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Telephone | 740-773-1141
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.439087
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN. 129950 IV
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License Number State | OH
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