Individual
MR. KENNETH NICLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
149 DURHAM DR, MAYNARDVILLE, TN 37807-2925
(865) 992-2221
(865) 992-2251
Mailing address
1225 E WEISGARBER RD, SUITE 200, KNOXVILLE, TN 37909-2604
(865) 584-4747
(865) 584-1363
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2416
TN
Other
Enumeration date
07/08/2014
Last updated
01/21/2015
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