Individual
CLISTY NICOLE EARLYWINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2666 THOMAS PIKE, MOUNT OLIVET, KY 41064-7450
(606) 748-9001
Mailing address
2666 THOMAS PIKE, MOUNT OLIVET, KY 41064-7450
(606) 748-9001
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4042462
KY
Other
Enumeration date
09/09/2025
Last updated
09/09/2025
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