Provider Demographics
NPI:1699761775
Name:NICKOSON, RONDA KATHERINE (APRN,CDE)
Entity type:Individual
Prefix:
First Name:RONDA
Middle Name:KATHERINE
Last Name:NICKOSON
Suffix:
Gender:F
Credentials:APRN,CDE
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 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-4000
Mailing Address - Fax:606-408-7425
Practice Address - Street 1:912 PARK AVE
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1596
Practice Address - Country:US
Practice Address - Phone:740-534-0021
Practice Address - Fax:740-534-0029
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09960-NP363LF0000X
KY3004637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2805325Medicaid
KY78014925Medicaid
OHNINP27131Medicare PIN
OHNP27132Medicare PIN
KY78014925Medicaid
KY0728212Medicare PIN
OH2805325Medicaid
KY0728212Medicare PIN