Healthcare Provider Details

I. General information

NPI: 1801417670
Provider Name (Legal Business Name): REBECCA LYNN NIKSICH AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2020
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 NEW DUTCHMANS PARKWAY
LOUISVILLE KY
40205
US

IV. Provider business mailing address

6400 NEW DUTCHMANS PARKWAY
LOUISVILLE KY
40205
US

V. Phone/Fax

Practice location:
  • Phone: 502-357-9919
  • Fax:
Mailing address:
  • Phone: 502-357-9919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberLD61072652
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number302916
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: