Provider Demographics
NPI:1760056295
Name:KILBY, NICHOLE (LPN)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:KILBY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:TN
Mailing Address - Zip Code:37829-2411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1313 AIRPROT RD
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:TN
Practice Address - Zip Code:37829
Practice Address - Country:US
Practice Address - Phone:865-236-9608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000070974164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse