Provider Demographics
NPI:1710324082
Name:WHITE, NICOLE LEE (DI)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 ARNETT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-9685
Mailing Address - Country:US
Mailing Address - Phone:270-537-4045
Mailing Address - Fax:
Practice Address - Street 1:159 ARNETT GROVE RD
Practice Address - Street 2:159 ARNETT GROVE RD.
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-9685
Practice Address - Country:US
Practice Address - Phone:270-537-4045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY201130296222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist