MEDICARE: MS. NIKKI DAWN GARDEPE

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	172V00000X	Community Health Worker
2	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1801370739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NIKKI DAWN GARDEPE

Provider Business Mailing Address
First Line	:	1141 CHELSEA ST
Second Line	:
City	:	RIDGECREST
State	:	CA
Zip	:	93555-3208
Country	:	US
Telephone Number	:	760-463-2880
Fax Number	:	760-446-0298

Provider Business Practice Location Address
First Line	:	1141 CHELSEA ST
Second Line	:
City	:	RIDGECREST
State	:	CA
Zip	:	93555-3208
Country	:	US
Telephone Number	:	760-463-2880
Fax Number	:	760-446-0298

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

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	04/23/2025

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