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General NPI Number Information
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NPI Number | 1962210005
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Entity Type | Individual
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Provider Name | NICOLE MARIE FIRESTONE APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 223 MAIN ST
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City | MOUND CITY
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State | KS
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Zip | 66056-5211
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Country | US
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Telephone | 785-304-1555
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Fax |
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Provider Business Mailing Address
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Address Line | 27057 NW MITCHELL RD
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City | GARNETT
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State | KS
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Zip | 66032-7245
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Country | US
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Telephone | 785-304-1555
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 13-115764-071
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 53-83945-071
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License Number State | KS
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