Provider Demographics
NPI:1821703737
Name:NICELY, LAYNE ROSS (TRAPSS)
Entity Type:Individual
Prefix:
First Name:LAYNE
Middle Name:ROSS
Last Name:NICELY
Suffix:
Gender:M
Credentials:TRAPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 COPPERAS LICK BR
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-8861
Mailing Address - Country:US
Mailing Address - Phone:606-276-1936
Mailing Address - Fax:
Practice Address - Street 1:77 COPPERAS LICK BR
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-8861
Practice Address - Country:US
Practice Address - Phone:606-276-1936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251903175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist