Provider Demographics
NPI:1346606159
Name:FOWORA, NIKAY BASIRATU
Entity Type:Individual
Prefix:MISS
First Name:NIKAY
Middle Name:BASIRATU
Last Name:FOWORA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BASIRATU
Other - Middle Name:NIKAY
Other - Last Name:FOWORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8979 ELLENBROOK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4981
Mailing Address - Country:US
Mailing Address - Phone:816-405-2044
Mailing Address - Fax:
Practice Address - Street 1:8979 ELLENBROOK ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4981
Practice Address - Country:US
Practice Address - Phone:816-405-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101YMO800X101YM0800X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health