Provider Demographics
NPI:1114485505
Name:RITCHIE, NIKIA DELORES (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:NIKIA
Middle Name:DELORES
Last Name:RITCHIE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 COMMERCE PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7386
Mailing Address - Country:US
Mailing Address - Phone:910-521-2900
Mailing Address - Fax:910-775-9165
Practice Address - Street 1:610 E DR MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-1800
Practice Address - Country:US
Practice Address - Phone:910-844-5253
Practice Address - Fax:910-844-3290
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1114485505OtherBCBSNC
NC1114485505Medicaid