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General NPI Number Information
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NPI Number | 1316376585
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Entity Type | Individual
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Provider Name | NIKEDA BURPHY
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Gender | Female
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 08/15/2021
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Provider Practice Location Address
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Address Line | 555 STOCKTON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-2534
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Country | US
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Telephone | 904-387-4661
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Fax |
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Provider Business Mailing Address
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Address Line | 7585 SUNNYDALE LN
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City | JACKSONVILLE
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State | FL
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Zip | 32256-1960
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Country | US
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Telephone | 323-715-0073
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH14272
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License Number State | FL
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