Provider Demographics
NPI:1730971466
Name:NICOLL, KYLA JEAN
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:JEAN
Last Name:NICOLL
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 520297
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:AK
Mailing Address - Zip Code:99652-0297
Mailing Address - Country:US
Mailing Address - Phone:907-203-9505
Mailing Address - Fax:
Practice Address - Street 1:1825 S CHUGACH ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6795
Practice Address - Country:US
Practice Address - Phone:907-746-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator