Provider Demographics
NPI:1568135200
Name:NICHOLS, HALIE BROOKE (NP-C)
Entity Type:Individual
Prefix:
First Name:HALIE
Middle Name:BROOKE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41183-9421
Mailing Address - Country:US
Mailing Address - Phone:606-585-1577
Mailing Address - Fax:
Practice Address - Street 1:1408 CAMPBELL DR
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-2301
Practice Address - Country:US
Practice Address - Phone:740-533-9719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.486282163W00000X
KY1140884163W00000X
KY3016243363L00000X
OHAPRN.CNP.0029222363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse