Provider Demographics
NPI:1154471985
Name:BREY, NICOLE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LYNN
Last Name:BREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:VESSELS
Other - Last Name:BREY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2915 NEW HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1323
Mailing Address - Country:US
Mailing Address - Phone:270-852-1645
Mailing Address - Fax:270-852-1646
Practice Address - Street 1:2915 NEW HARTFORD RD.
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-852-1645
Practice Address - Fax:270-852-1646
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40950207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY40950OtherMEDICAL LICENSE
KY01479Medicare PIN
KY173588Medicare UPIN