Provider Demographics
NPI:1366010399
Name:AGUAS, ALLISON NICHOLE
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:NICHOLE
Last Name:AGUAS
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 1:146 HEFT AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON JUNCTION
Mailing Address - State:KY
Mailing Address - Zip Code:40150-8401
Mailing Address - Country:US
Mailing Address - Phone:502-921-3074
Mailing Address - Fax:
Practice Address - Street 1:119 E SANDERS LN
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-7557
Practice Address - Country:US
Practice Address - Phone:502-251-3821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1141508364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care