Provider Demographics
NPI:1760645071
Name:NICKLES, PAULA
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:
Last Name:NICKLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 257
Mailing Address - Street 2:
Mailing Address - City:TOPMOST
Mailing Address - State:KY
Mailing Address - Zip Code:41862-0257
Mailing Address - Country:US
Mailing Address - Phone:606-447-2919
Mailing Address - Fax:606-447-3339
Practice Address - Street 1:3521 STATE ROUTE7
Practice Address - Street 2:
Practice Address - City:DEMA
Practice Address - State:KY
Practice Address - Zip Code:41859
Practice Address - Country:US
Practice Address - Phone:606-447-2919
Practice Address - Fax:606-447-3339
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor