Healthcare Provider Details

I. General information

NPI: 1457654600
Provider Name (Legal Business Name): NIKKI S HOUSTON RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 CHATTANOOGA PL APT 1222
DALLAS TX
75235-6100
US

IV. Provider business mailing address

1716 CHATTANOOGA PL APT 1222
DALLAS TX
75235-6100
US

V. Phone/Fax

Practice location:
  • Phone: 214-650-7943
  • Fax:
Mailing address:
  • Phone: 214-650-7943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number68531
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: