Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 39009 | KY |
N | 111NI0900X | Internist | 39009 | KY |
Y | 207RH0002X | Hospice and Palliative Medicine | 39009 | KY |
NPI | 1336197078 |
---|---|
Provider Name | Dr. Katrina Nickels |
First Address | Lexington, KY 40504-3229 |
Second Address | Lexington, KY 40504-3229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 09/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64101462 | (05) | KY |
I32638 | (02) |