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Organization

KIM SICKELS NURSE PRACTITIONER, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KIM ANNETTE SICKELS NURSE PRACTITIONER (NURSE PRACTITIONER)
(502) 939-9754
Entity
Organization

Contact information

Practice address
3103 HERITAGE HEIGHTS WAY, JEFFERSONVILLE, IN 47130-8934
(502) 939-9754
(812) 284-6550
Mailing address
3103 HERITAGE HEIGHTS WAY, JEFFERSONVILLE, IN 47130-8934
(502) 939-9754
(812) 284-6550

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
4488P
KY
363LA2200X
Adult Health Nurse Practitioner
Primary
71000724A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00410
MEDICARE GROUP
KY
05
200222290B
IN
05
78007168
KY
Enumeration date
05/22/2007
Last updated
12/05/2007
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