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General NPI Number Information
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NPI Number | 1669204319
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Entity Type | Individual
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Provider Name | NIKKI IRWIN
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Gender | Female
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 11/02/2025
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Provider Practice Location Address
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Address Line | 2300 CLEAR CREEK RD STE 102
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City | KILLEEN
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State | TX
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Zip | 76549-4985
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Country | US
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Telephone | 254-554-2637
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Fax |
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Provider Business Mailing Address
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Address Line | 5402 OTHELLO DR
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City | BELTON
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State | TX
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Zip | 76513-5875
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Country | US
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Telephone |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2139411
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3134436
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License Number State | TX
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