Provider Demographics
NPI:1164033015
Name:HOWARD, NIKKI RENEE
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:RENEE
Last Name:HOWARD
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 1:4701 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-6439
Mailing Address - Country:US
Mailing Address - Phone:325-514-3770
Mailing Address - Fax:580-226-6727
Practice Address - Street 1:2530 S COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5519
Practice Address - Country:US
Practice Address - Phone:325-514-3770
Practice Address - Fax:580-226-6727
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator