Provider Demographics
NPI:1659462166
Name:FUNK, NIKOLE (DO)
Entity type:Individual
Prefix:
First Name:NIKOLE
Middle Name:
Last Name:FUNK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40412
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-1255
Mailing Address - Country:US
Mailing Address - Phone:248-824-6500
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:2452 SIR BARTON WAY STE 303
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2826
Practice Address - Country:US
Practice Address - Phone:859-340-3233
Practice Address - Fax:855-998-8574
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008699207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine