MEDICARE: NIKKI LIGHTNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	958	NE
2	101YM0800X	Mental Health Counselor	1316	NE

General Provider Information

NPI Number	:	1508173386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKI LIGHTNER

Provider Business Mailing Address
First Line	:	5301 QUARRY LEDGE RD.
Second Line	:
City	:	ROCA
State	:	NE
Zip	:	68430
Country	:	US
Telephone Number	:	402-475-8717
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 QUARRY LEDGE RD.
Second Line	:
City	:	ROCA
State	:	NE
Zip	:	68430
Country	:	US
Telephone Number	:	402-416-2790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2010
Last Update Date	:	01/13/2023

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Directions to “ NIKKI LIGHTNER ” Practice Location

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