Healthcare Provider Details

I. General information

NPI: 1629309018
Provider Name (Legal Business Name): NIKITA N DUKE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N LOCUST AVE
LAWRENCEBURG TN
38464-3757
US

IV. Provider business mailing address

PO BOX 681029
FRANKLIN TN
37068-1029
US

V. Phone/Fax

Practice location:
  • Phone: 855-560-4999
  • Fax:
Mailing address:
  • Phone: 855-560-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3012363
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number24063
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-117650
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: