Provider Demographics
NPI:1750464517
Name:NICHOLS, DEANNA ARLENE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:ARLENE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:200 N CRAWFORD STREET SUITE 3
Mailing Address - City:TOMPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42167-0669
Mailing Address - Country:US
Mailing Address - Phone:270-407-5052
Mailing Address - Fax:270-407-5053
Practice Address - Street 1:200 N CRAWFORD ST STE 3
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167-1617
Practice Address - Country:US
Practice Address - Phone:270-407-5052
Practice Address - Fax:270-407-5053
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1103764OtherRN LISCENSE