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General NPI Number Information
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NPI Number | 1609275049
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Entity Type | Individual
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Provider Name | NICKI DAWN MARTIN APRN,FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/21/2014
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 277 GREASY RIDGE RD
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City | PRINCETON
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State | WV
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Zip | 24739-6900
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Country | US
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Telephone | 304-425-7615
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Fax | 304-425-7635
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Provider Business Mailing Address
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Address Line | 186 ELDER AVE
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City | PRINCETON
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State | WV
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Zip | 24739
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Country | US
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Telephone | 762-340-9353
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Fax | 404-645-7572
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN68714-FNP-BC
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024172549
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN68714-FNP-BC
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License Number State | WV
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