Provider Demographics
NPI:1730525676
Name:WHITFIELD, NICOLLETTE RENEE (MSN, CRNA)
Entity type:Individual
Prefix:MRS
First Name:NICOLLETTE
Middle Name:RENEE
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:MSN, CRNA
Other - Prefix:
Other - First Name:NICOLLETTE
Other - Middle Name:RENEE
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:320 WHITTINGTON PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4928
Mailing Address - Country:US
Mailing Address - Phone:502-625-5584
Mailing Address - Fax:502-426-2264
Practice Address - Street 1:320 WHITTINGTON PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4928
Practice Address - Country:US
Practice Address - Phone:502-625-5584
Practice Address - Fax:502-426-2264
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1136048163W00000X
KY3008087367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100259690Medicaid
KYK098318OtherMEDICARE
IN201186460Medicaid