Healthcare Provider Details

I. General information

NPI: 1487404190
Provider Name (Legal Business Name): NIKIESHA ROLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S MEMORIAL DR
NEW CASTLE IN
47362-4904
US

IV. Provider business mailing address

PO BOX 306504
NASHVILLE TN
37230-6504
US

V. Phone/Fax

Practice location:
  • Phone: 765-518-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71015102A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: