Provider Demographics
NPI:1447709159
Name:NICHOLS, KELLY (APRN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:APRN
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2605 KENTUCKY AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3800
Mailing Address - Country:US
Mailing Address - Phone:270-415-7653
Mailing Address - Fax:270-575-8359
Practice Address - Street 1:2601 KENTUCKY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3817
Practice Address - Country:US
Practice Address - Phone:270-443-5564
Practice Address - Fax:270-443-5549
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2020-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3010752363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care