Individual
DYLAN BLADE NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
KCPSS
Contact information
Practice address
451 QUISENBERRY RD, CAMPBELLSVILLE, KY 42718-8005
(270) 937-4898
Mailing address
109 KENSINGTON WAY, CAMPBELLSVILLE, KY 42718-9548
(270) 849-8199
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
1208146
KY
Other
Enumeration date
12/08/2023
Last updated
12/08/2023
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