Provider Demographics
NPI:1225025356
Name:NANCE, NICOLA S (ARNP)
Entity Type:Individual
Prefix:
First Name:NICOLA
Middle Name:S
Last Name:NANCE
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:PO BOX 8148
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-8148
Mailing Address - Country:US
Mailing Address - Phone:270-443-8425
Mailing Address - Fax:270-442-3303
Practice Address - Street 1:2311 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3243
Practice Address - Country:US
Practice Address - Phone:270-443-8425
Practice Address - Fax:270-442-3308
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2327M367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78014495Medicaid
KY1257507Medicare PIN
KY78014495Medicaid