Provider Demographics
NPI:1356301584
Name:NICKELS, LINDA S (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:S
Last Name:NICKELS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:S
Other - Last Name:NICKELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:3521 MCINTOSH DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2915
Mailing Address - Country:US
Mailing Address - Phone:423-239-6462
Mailing Address - Fax:
Practice Address - Street 1:951 HIGHWAY 126
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-3353
Practice Address - Country:US
Practice Address - Phone:423-844-6840
Practice Address - Fax:423-844-6844
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14324164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse