Provider Demographics
NPI:1285217182
Name:NICKENS, AVA T (APRN, CRNP)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:T
Last Name:NICKENS
Suffix:
Gender:F
Credentials:APRN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 EASY ST
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3129
Mailing Address - Country:US
Mailing Address - Phone:724-320-0849
Mailing Address - Fax:
Practice Address - Street 1:211 EASY ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3129
Practice Address - Country:US
Practice Address - Phone:724-320-0849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV109023363LF0000X
PASP023775363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily