MEDICARE: MS. JONI FERGUSON NICKENS NP

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	363LF0000X	Family Nurse Practitioner	RN062230AP03515	LA

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	:	1831196096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JONI FERGUSON NICKENS NP

Provider Business Mailing Address
First Line	:	42076 HIGHWAY 933
Second Line	:
City	:	PRAIRIEVILLE
State	:	LA
Zip	:	70769-6106
Country	:	US
Telephone Number	:	225-622-2048
Fax Number	:	225-319-4595

Provider Business Practice Location Address
First Line	:	4560 NORTH BLVD
Second Line	:	STE 101
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-4043
Country	:	US
Telephone Number	:	225-341-5901
Fax Number	:	225-341-5903

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

Provider Enumeration Date	:	07/03/2005
Last Update Date	:	12/19/2012

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