Provider Demographics
NPI:1023663770
Name:ROMINE, NICOLE REBECCA (FNP-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:REBECCA
Last Name:ROMINE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:REBECCA
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6530 TROOST AVE STE A
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1301
Mailing Address - Country:US
Mailing Address - Phone:816-361-0670
Mailing Address - Fax:816-444-6936
Practice Address - Street 1:6530 TROOST AVE STE A
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1301
Practice Address - Country:US
Practice Address - Phone:816-361-0670
Practice Address - Fax:816-444-6936
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78776-012363LF0000X
MO2019024726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily