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NPI Code Detail

MEDICARE: NIKI DEEDS PA-C

MEDICARE: NIKI DEEDS PA-C
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
1363AM0700XMedical Physician Assistant1617NE
2363AS0400XSurgical Physician AssistantAPPLYING

General Provider Information

NPI Number : 1679840284
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIKI DEEDS PA-C
Provider Business Mailing Address
First Line : 2603 WILSON ST
Second Line :
City : FALLS CITY
State : NE
Zip : 68355-1219
Country : US
Telephone Number : 402-598-2335
Fax Number :
Provider Business Practice Location Address
First Line : 3307 BARADA ST
Second Line :
City : FALLS CITY
State : NE
Zip : 68355-2470
Country : US
Telephone Number : 402-245-6582
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2011
Last Update Date : 07/22/2014

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Directions to “ NIKI DEEDS PA-C” Practice Location

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