Provider Demographics
NPI:1871266676
Name:BISCHOFF, NICHOLAS AUSTEN (APRN)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:AUSTEN
Last Name:BISCHOFF
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:NICHOLAS
Other - Middle Name:AUSTEN BLAKE
Other - Last Name:BISCHOFF-NUNLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3101 WALL ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1711
Mailing Address - Country:US
Mailing Address - Phone:859-219-6440
Mailing Address - Fax:859-219-6449
Practice Address - Street 1:3101 WALL ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1711
Practice Address - Country:US
Practice Address - Phone:859-219-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1165642163W00000X
KY3016559363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse