Individual provider Active NPI

Nicole Fedorko, MSW, CSW

  • Case Manager/Care Coordinator
  • Lexington, KY
National Provider Identifier
1679955405
Registry record updated Jul 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
1351 Newtown Pike
Building #5
Lexington, KY 40511-1275
Phone
(859) 254-3106
NPI assigned
Jun 29, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X Primary

Addresses

Primary practice location

1351 Newtown Pike
Building #5
Lexington, KY 40511-1275

Mailing address

1351 Newtown Pike
Building #5
Lexington, KY 40511-1275

Other identifiers 1

IdentifierTypeStateIssuer
1790731081MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1435536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436313600000",
    "number": "1679955405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 NEWTOWN PIKE",
            "address_2": "BUILDING #5",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405111275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 NEWTOWN PIKE",
            "address_2": "BUILDING #5",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405111275",
            "telephone_number": "859-254-3106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDORKO",
        "first_name": "NICOLE",
        "credential": "MSW, CSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-29",
        "last_updated": "2015-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790731081",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2015; 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.