Provider Demographics
NPI:1326651118
Name:JACINTO, NIKKI LEANN (APRN)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:LEANN
Last Name:JACINTO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 ED F DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-1053
Mailing Address - Country:US
Mailing Address - Phone:580-931-8180
Mailing Address - Fax:580-931-8015
Practice Address - Street 1:2149 ED F DAVIS RD
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-1053
Practice Address - Country:US
Practice Address - Phone:580-931-8180
Practice Address - Fax:580-931-8015
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK113965363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner