Provider Demographics
NPI:1134969371
Name:NICHOLS, SYDNEY TAYLOR (PA)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:TAYLOR
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-6200
Mailing Address - Fax:859-258-6203
Practice Address - Street 1:1401 HARRODSBURG RD STE C215
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1780
Practice Address - Country:US
Practice Address - Phone:859-258-6450
Practice Address - Fax:859-258-6499
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA3566363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100998370Medicaid