Individual
NICOLE FEDORKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, CSW
Contact information
Practice address
1351 NEWTOWN PIKE, BUILDING #5, LEXINGTON, KY 40511-1275
(859) 254-3106
Mailing address
1351 NEWTOWN PIKE, BUILDING #5, LEXINGTON, KY 40511-1275
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
Enumeration date
06/29/2015
Last updated
07/08/2015
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