Individual
KRISTIN NICKLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1805 27TH STREET, PORTSMOUTH, OH 45662-3250
(740) 356-2567
(740) 356-2509
Mailing address
1735 27TH ST STE B06, PORTSMOUTH, OH 45662-2681
(740) 356-8034
(740) 356-7900
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN.CNP.020180
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0193016
—
OH
05
—
7100474830
—
KY
Enumeration date
10/21/2016
Last updated
12/18/2020
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