Provider Demographics
NPI:1053892448
Name:SALLEE, INIKO ZEVON (APRN/CNM)
Entity type:Individual
Prefix:
First Name:INIKO
Middle Name:ZEVON
Last Name:SALLEE
Suffix:
Gender:F
Credentials:APRN/CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 NICHOLASVILLE RD STE 702
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1489
Mailing Address - Country:US
Mailing Address - Phone:859-264-8811
Mailing Address - Fax:859-264-8822
Practice Address - Street 1:1720 NICHOLASVILLE RD STE 702
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1489
Practice Address - Country:US
Practice Address - Phone:859-264-8811
Practice Address - Fax:859-264-8822
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012613363L00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100556430Medicaid