Kim Sickels Nurse Practitioner, LLC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

71000724A Issued in IN

Legal business name

KIM SICKELS NURSE PRACTITIONER, LLC

Practice address

3103 Heritage Heights Way
Jeffersonville, IN 47130-8934

Phone

(502) 939-9754

Fax

(812) 284-6550

NPI assigned

May 22, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kim Annette Sickels, NURSE PRACTITIONER

Title

Nurse Practitioner

Phone

(502) 939-9754

Specialties & licenses 2

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196812800000",
    "number": "1447469580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3103 HERITAGE HEIGHTS WAY",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471308934",
            "telephone_number": "502-939-9754",
            "fax_number": "812-284-6550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3103 HERITAGE HEIGHTS WAY",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471308934",
            "telephone_number": "502-939-9754",
            "fax_number": "812-284-6550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIM SICKELS NURSE PRACTITIONER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2007-12-05",
        "status": "A",
        "authorized_official_last_name": "SICKELS",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "ANNETTE",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "502-939-9754",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71000724A",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "KY",
            "license": "4488P",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "00410",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78007168",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200222290B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jenna Kietzman, OTD, OTR
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• Hailee Brooke King, RBT

• Adult Health Nurse Practitioner in Jeffersonville, IN
• Providers in Jeffersonville, IN by specialty
• Adult Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.