Provider Demographics
NPI:1114368586
Name:EASTERLING, NIKKI RAE (MED, CDP, CCDOULA)
Entity Type:Individual
Prefix:MS
First Name:NIKKI
Middle Name:RAE
Last Name:EASTERLING
Suffix:
Gender:F
Credentials:MED, CDP, CCDOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 W 7TH AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2806
Mailing Address - Country:US
Mailing Address - Phone:509-496-3143
Mailing Address - Fax:509-276-6782
Practice Address - Street 1:703 W 7TH AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2806
Practice Address - Country:US
Practice Address - Phone:509-496-3143
Practice Address - Fax:509-276-6782
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00003766101YA0400X
171M00000X, 174N00000X, 174H00000X, 374J00000X, 103K00000X
WACL60426086101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional