Provider Demographics
NPI:1982310124
Name:NUCKOLS, ABIGAIL
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:NUCKOLS
Suffix:
Gender:F
Credentials:
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 16
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:WV
Mailing Address - Zip Code:25938-0016
Mailing Address - Country:US
Mailing Address - Phone:304-663-9927
Mailing Address - Fax:
Practice Address - Street 1:13 MELINDA DR.
Practice Address - Street 2:
Practice Address - City:MT LOOKOUT
Practice Address - State:WV
Practice Address - Zip Code:26678
Practice Address - Country:US
Practice Address - Phone:304-663-9927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant