Provider Demographics
NPI:1033440375
Name:NICKELL, LENA ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:ANN
Last Name:NICKELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 WILSON AVE
Mailing Address - Street 2:FL 1
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1947
Mailing Address - Country:US
Mailing Address - Phone:859-879-0111
Mailing Address - Fax:859-879-0363
Practice Address - Street 1:624 CHAMBERLIN AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4220
Practice Address - Country:US
Practice Address - Phone:502-227-2285
Practice Address - Fax:502-227-1465
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6306P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily