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NPI Code Detail

MEDICARE: NICOLE R OURS DO

MEDICARE: NICOLE R OURS DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician2732WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
136745OTHERSCLICENSE
22732OTHERWVLICENSE

General Provider Information

NPI Number : 1053608588
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE R OURS DO
Provider Business Mailing Address
First Line : PO BOX 97
Second Line :
City : BAKER
State : WV
Zip : 26801-0097
Country : US
Telephone Number : 803-435-5270
Fax Number : 304-897-5915
Provider Business Practice Location Address
First Line : 422 S MAIN ST
Second Line :
City : MOOREFIELD
State : WV
Zip : 26836-1238
Country : US
Telephone Number : 304-538-2331
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2011
Last Update Date : 02/11/2025

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