Individual
DEBRA F. NICKELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
3061 FIELDSTONE WAY, SUITE 700, LEXINGTON, KY 40513-1718
(859) 296-9900
(859) 296-9603
Mailing address
3061 FIELDSTONE WAY, SUITE 700, LEXINGTON, KY 40513-1718
(859) 296-9900
(859) 296-9603
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA400
KY
363AM0700X
Medical Physician Assistant
PA400
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
05
—
95004008
—
KY
01
—
CB5773
RR MEDICARE GROUP
—
Enumeration date
09/26/2006
Last updated
11/02/2007
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