Provider Demographics
NPI:1518732841
Name:LEGRAND, NIKKI M
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:M
Last Name:LEGRAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:M
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 HEEB ST
Mailing Address - Street 2:
Mailing Address - City:CHAFFEE
Mailing Address - State:MO
Mailing Address - Zip Code:63740-1314
Mailing Address - Country:US
Mailing Address - Phone:573-887-1469
Mailing Address - Fax:
Practice Address - Street 1:20794 US HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-7260
Practice Address - Country:US
Practice Address - Phone:573-471-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015002018225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant