Provider Demographics
NPI:1598457657
Name:MANN, CIARA NICOLE (APRN)
Entity Type:Individual
Prefix:
First Name:CIARA
Middle Name:NICOLE
Last Name:MANN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PAVILION PKWY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-2998
Mailing Address - Country:US
Mailing Address - Phone:859-652-7203
Mailing Address - Fax:
Practice Address - Street 1:130 PAVILION PKWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2998
Practice Address - Country:US
Practice Address - Phone:859-652-7203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily