MR. Kenneth Nicley, PA

NPI #1306252598 in Maynardville, Tennessee

Provider Information

NPI Number: 1306252598
Entity Type: Individual
Name: MR. Kenneth Nicley, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Jul 8, 2014
Last Updated: Jan 21, 2015

Practice Location

Address: 149 DURHAM DR
City: Maynardville
State: Tennessee
ZIP Code: 37807-2925
Phone: (865) 992-2221

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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