Provider Demographics
NPI:1326283979
Name:NKEM, NINA
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:
Last Name:NKEM
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NNENNA
Other - Middle Name:
Other - Last Name:NKEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:7015 WESTFORD PARK LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-7847
Mailing Address - Country:US
Mailing Address - Phone:832-885-4001
Mailing Address - Fax:
Practice Address - Street 1:7015 WESTFORD PARK LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-7847
Practice Address - Country:US
Practice Address - Phone:832-885-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305S00000XManaged Care OrganizationsPoint of Service
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child