Provider Demographics
NPI:1518230697
Name:MOORE, NIKKI D (MHPP)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:D
Last Name:MOORE
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1487 W KEISER AVE STE I
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72370-2806
Mailing Address - Country:US
Mailing Address - Phone:870-563-4500
Mailing Address - Fax:
Practice Address - Street 1:1487 WEST KEISER AVE STE I
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370
Practice Address - Country:US
Practice Address - Phone:870-563-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator