Basic Information
| Provider Information | |||||||||
| NPI: | 1609270388 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLEVINGER | ||||||||
| FirstName: | NICOLE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1720 NICHOLASVILLE RD | ||||||||
| Address2: | SUITE 601 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405031404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592775887 | ||||||||
| FaxNumber: | 8592767659 | ||||||||
| Practice Location | |||||||||
| Address1: | 1720 NICHOLASVILLE RD | ||||||||
| Address2: | SUITE 601 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405031404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592775887 | ||||||||
| FaxNumber: | 8592767659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2014 | ||||||||
| LastUpdateDate: | 12/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 3009012 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.