Provider Demographics
NPI:1487207973
Name:BURCHETT, NICOLE (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BURCHETT
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HURRICANE BR
Mailing Address - Street 2:
Mailing Address - City:BOONS CAMP
Mailing Address - State:KY
Mailing Address - Zip Code:41204-8512
Mailing Address - Country:US
Mailing Address - Phone:606-793-1683
Mailing Address - Fax:
Practice Address - Street 1:625 JAMES S. TRIMBLE BLVD
Practice Address - Street 2:
Practice Address - City:PAINTSVILE
Practice Address - State:KY
Practice Address - Zip Code:41240
Practice Address - Country:US
Practice Address - Phone:606-789-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013544363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily