Healthcare Provider Details

I. General information

NPI: 1902204258
Provider Name (Legal Business Name): NIKKI CHEN ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKKI LASHAY DEAN

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 EAST LEE STREET STE C
ENTERPRISE AL
36330
US

IV. Provider business mailing address

805 EAST LEE STREET STE C
ENTERPRISE AL
36330
US

V. Phone/Fax

Practice location:
  • Phone: 334-348-8818
  • Fax: 334-393-8773
Mailing address:
  • Phone: 334-348-8818
  • Fax: 334-393-8773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-126856
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9382341
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: