MEDICARE: SYDNEY TAYLOR NICHOLS PA

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
1	363A00000X	Physician Assistant	PA3566	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134969371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY TAYLOR NICHOLS PA

Provider Business Mailing Address
First Line	:	1221 S BROADWAY
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-2701
Country	:	US
Telephone Number	:	859-258-6200
Fax Number	:	859-258-6203

Provider Business Practice Location Address
First Line	:	1401 HARRODSBURG RD STE C215
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-1780
Country	:	US
Telephone Number	:	859-258-6450
Fax Number	:	859-258-6499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2024
Last Update Date	:	06/11/2026

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