Healthcare Provider Details

I. General information

NPI: 1194457259
Provider Name (Legal Business Name): NIKKI DANIELLE BARTLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKKI DANIELLE SNOW

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8408 STACY RD STE 300
MCKINNEY TX
75070-2422
US

IV. Provider business mailing address

300 INTERNATIONAL PKWY STE 200
LAKE MARY FL
32746-5028
US

V. Phone/Fax

Practice location:
  • Phone: 469-625-2193
  • Fax:
Mailing address:
  • Phone: 866-610-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: