Healthcare Provider Details

I. General information

NPI: 1063109502
Provider Name (Legal Business Name): NIKKI TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 MORVEN RD
WADESBORO NC
28170-2834
US

IV. Provider business mailing address

904 MORVEN RD
WADESBORO NC
28170-2834
US

V. Phone/Fax

Practice location:
  • Phone: 704-994-2300
  • Fax:
Mailing address:
  • Phone: 704-994-2300
  • Fax: 704-994-2353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-14145
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: