# ANN LOUISE NICELY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1265588271
- **Gender:** F
- **Credential:** PHYSICIAN ASSISTANT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 00375 | WV | — |
| 363A00000X | Physician Assistant | 464 | WV | Yes |

## Other

- **Enumeration date:** 01/25/2007
- **Last updated:** 05/06/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | P00455326 | RR MEDICARE | WV |
| 01 | — | S99643 | WV WORKER'S COMP | WV |