Provider Demographics
NPI:1508903204
Name:NICHOLS, DEBORAH ANN (RD)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:547 SPRINGHILL RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1045
Mailing Address - Country:US
Mailing Address - Phone:859-236-5982
Mailing Address - Fax:859-236-2649
Practice Address - Street 1:475 WHIRLAWAY DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-9036
Practice Address - Country:US
Practice Address - Phone:859-236-5982
Practice Address - Fax:859-236-2649
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY- 0147133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0925601Medicare ID - Type UnspecifiedPIN- MEDICARE