Basic Information
| Provider Information | |||||||||
| NPI: | 1134521388 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NICHOLAS COUNTY URGENT TREATMENT PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2330 CONCRETE RD | ||||||||
| Address2: | |||||||||
| City: | CARLISLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403119700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594054025 | ||||||||
| FaxNumber: | 8595173014 | ||||||||
| Practice Location | |||||||||
| Address1: | 2330 CONCRETE RD | ||||||||
| Address2: | |||||||||
| City: | CARLISLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403119700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594054025 | ||||||||
| FaxNumber: | 8595173014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2014 | ||||||||
| LastUpdateDate: | 06/28/2016 | ||||||||
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| AuthorizedOfficialLastName: | HUNTER | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | COX | ||||||||
| AuthorizedOfficialTitleorPosition: | APRN | ||||||||
| AuthorizedOfficialTelephone: | 8594054025 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | KY | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 363LF0000X | KY | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 7100347640 | 05 | KY | MEDICAID |