Provider Demographics
NPI:1346847878
Name:RUNNELS, LAKEN NICOLE (APRN)
Entity Type:Individual
Prefix:
First Name:LAKEN
Middle Name:NICOLE
Last Name:RUNNELS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 WILSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-6501
Mailing Address - Country:US
Mailing Address - Phone:859-582-9695
Mailing Address - Fax:
Practice Address - Street 1:107 MERIDIAN WAY STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2878
Practice Address - Country:US
Practice Address - Phone:859-624-6366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily