Provider Demographics
NPI:1083035281
Name:NICHOLS, TRACY (RN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1096 LONG BR
Mailing Address - Street 2:
Mailing Address - City:ARGILLITE
Mailing Address - State:KY
Mailing Address - Zip Code:41121-8593
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1096 LONG BR
Practice Address - Street 2:
Practice Address - City:ARGILLITE
Practice Address - State:KY
Practice Address - Zip Code:41121-8593
Practice Address - Country:US
Practice Address - Phone:606-831-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1128427163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory