Healthcare Provider Details

I. General information

NPI: 1871431767
Provider Name (Legal Business Name): KARLEE FAYE NICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 S SERVICE RD W STE 10
SULLIVAN MO
63080-2306
US

IV. Provider business mailing address

306 E PETERS AVE
OWENSVILLE MO
65066-1141
US

V. Phone/Fax

Practice location:
  • Phone: 573-468-4455
  • Fax: 573-468-4451
Mailing address:
  • Phone: 573-569-5214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025053007
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: