Provider Demographics
NPI:1528166261
Name:KOUNS, NICHOLAS SHANE (DO)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:SHANE
Last Name:KOUNS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4140
Mailing Address - Street 2:1107 WEST LEXINGTON AVENUE
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40392-4140
Mailing Address - Country:US
Mailing Address - Phone:859-745-6471
Mailing Address - Fax:859-744-0257
Practice Address - Street 1:1107 W LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1169
Practice Address - Country:US
Practice Address - Phone:859-745-6471
Practice Address - Fax:859-744-0257
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02393208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000356894OtherBLUE CROSS
KY64023930Medicaid
KYC76619Medicare UPIN
KY64023930Medicaid