MEDICARE: MRS. NICKI DAWN MARTIN APRN,FNP-BC

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	363L00000X	Nurse Practitioner	APRN68714-FNP-BC	WV
2	363LF0000X	Family Nurse Practitioner	0024172549	VA
3	363LF0000X	Family Nurse Practitioner	APRN68714-FNP-BC	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609275049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICKI DAWN MARTIN APRN,FNP-BC

Provider Business Mailing Address
First Line	:	186 ELDER AVE
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24739
Country	:	US
Telephone Number	:	762-340-9353
Fax Number	:	404-645-7572

Provider Business Practice Location Address
First Line	:	277 GREASY RIDGE RD
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24739-6900
Country	:	US
Telephone Number	:	304-425-7615
Fax Number	:	304-425-7635

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

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	09/20/2024

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