Provider Demographics
NPI:1518591023
Name:MAXEY, NIKKI (NP)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:MAXEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:MCCRACKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9302 N MERIDIAN ST STE 235
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1337
Mailing Address - Country:US
Mailing Address - Phone:317-975-3945
Mailing Address - Fax:
Practice Address - Street 1:9302 N MERIDIAN ST STE 235
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1337
Practice Address - Country:US
Practice Address - Phone:317-975-3945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF05191055363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner