Provider Demographics
NPI:1073086187
Name:KING, NIKITA FAYE
Entity Type:Individual
Prefix:MS
First Name:NIKITA
Middle Name:FAYE
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11084 CHANDLER WAY
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-5349
Mailing Address - Country:US
Mailing Address - Phone:317-909-7683
Mailing Address - Fax:
Practice Address - Street 1:11084 CHANDLER WAY
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-5349
Practice Address - Country:US
Practice Address - Phone:317-909-7683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty