Provider Demographics
NPI:1881788040
Name:NICHOLS, JOE A (MD)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:A
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031
Mailing Address - Country:US
Mailing Address - Phone:859-234-1900
Mailing Address - Fax:
Practice Address - Street 1:206 E PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031
Practice Address - Country:US
Practice Address - Phone:859-234-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13681208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64136815Medicaid
1181601Medicare ID - Type Unspecified
C71141Medicare UPIN