Basic Information
| Provider Information | |||||||||
| NPI: | 1033440375 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICKELL | ||||||||
| FirstName: | LENA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 WILSON AVE | ||||||||
| Address2: | FL 1 | ||||||||
| City: | VERSAILLES | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403831947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8598790111 | ||||||||
| FaxNumber: | 8598790363 | ||||||||
| Practice Location | |||||||||
| Address1: | 624 CHAMBERLIN AVE | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 406014220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022272285 | ||||||||
| FaxNumber: | 5022271465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2010 | ||||||||
| LastUpdateDate: | 08/31/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 6306P | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.