Healthcare Provider Details

I. General information

NPI: 1649091141
Provider Name (Legal Business Name): NIKKI RENEE JEFFERIES PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 PARK AVE
DANVILLE VA
24541-4622
US

IV. Provider business mailing address

530 PARK AVE
DANVILLE VA
24541-4622
US

V. Phone/Fax

Practice location:
  • Phone: 434-204-8620
  • Fax: 434-240-6058
Mailing address:
  • Phone: 434-770-5331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5021033
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: