MEDICARE: NAKIA MCKIBBEN

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	253J00000X	Foster Care Agency

General Provider Information

NPI Number	:	1912245861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAKIA MCKIBBEN

Provider Business Mailing Address
First Line	:	3155 E PATRICK LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3496
Country	:	US
Telephone Number	:	702-992-0576
Fax Number	:

Provider Business Practice Location Address
First Line	:	3155 E PATRICK LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3496
Country	:	US
Telephone Number	:	702-992-0576
Fax Number	:

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

Provider Enumeration Date	:	01/28/2013
Last Update Date	:	01/28/2013

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Directions to “ NAKIA MCKIBBEN ” Practice Location

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