Healthcare Provider Details

I. General information

NPI: 1720347289
Provider Name (Legal Business Name): NIKKO FARMER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 05/26/2024
Certification Date: 05/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 AUCHLY LN
SAINT PETERS MO
63376-2036
US

IV. Provider business mailing address

4 AUCHLY LN
SAINT PETERS MO
63376-2036
US

V. Phone/Fax

Practice location:
  • Phone: 314-435-8424
  • Fax: 866-950-4040
Mailing address:
  • Phone: 314-435-8424
  • Fax: 866-950-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2000149870
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number2000149870
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number2000149870
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number2000149870
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number2000149870
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number2000149870
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number200149870
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number2000149870
License Number StateMO
# 10
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 11
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 12
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 13
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: