Provider Demographics
NPI:1275132797
Name:MARTIN, NIKALETTA BISHOP
Entity Type:Individual
Prefix:
First Name:NIKALETTA
Middle Name:BISHOP
Last Name:MARTIN
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 1:33 FUZZY TAIL DR
Mailing Address - Street 2:
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-4877
Mailing Address - Country:US
Mailing Address - Phone:813-360-3615
Mailing Address - Fax:
Practice Address - Street 1:33 FUZZY TAIL DR
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-4877
Practice Address - Country:US
Practice Address - Phone:813-360-3615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant