Provider Demographics
NPI:1114547031
Name:COLE, RACHEL NICOLE
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:NICOLE
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 DRY BR
Mailing Address - Street 2:
Mailing Address - City:OIL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:41238-9109
Mailing Address - Country:US
Mailing Address - Phone:606-297-9435
Mailing Address - Fax:
Practice Address - Street 1:79 SPARROW ST
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1336
Practice Address - Country:US
Practice Address - Phone:606-886-9178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1120275OtherRN LICENSE
KY3014862OtherAPRN