Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 55244 | KY |
NPI | 1336534932 |
---|---|
Provider Name | Alexis Nickols |
First Address | Lexington, KY 40536-7001 |
Second Address | Lexington, KY 40536-5346 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2015 |
Last Update Date | 31/07/2021 |