Provider Demographics
NPI:1568421527
Name:ANDERSON, NIKKI LYNN (RD, CDE, LD)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RD, CDE, LD
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:LYNN
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD, CDE
Mailing Address - Street 1:843 FAIRVIEW AVE
Mailing Address - Street 2:SUITE B6
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-4914
Mailing Address - Country:US
Mailing Address - Phone:270-901-9412
Mailing Address - Fax:270-901-3413
Practice Address - Street 1:843 FAIRVIEW AVE
Practice Address - Street 2:SUITE B6
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4914
Practice Address - Country:US
Practice Address - Phone:270-901-3412
Practice Address - Fax:270-901-3413
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2332133V00000X
KY1700133V00000X
KY20720185163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000713744OtherANTHEM
TN7781604OtherAETNA
KYP00996162OtherRAILROAD MEDICARE
TN103I719674Medicare PIN
KYP00996162OtherRAILROAD MEDICARE