Provider Demographics
NPI:1598453706
Name:DEAS, NIKKI R (PA-3)
Entity Type:Individual
Prefix:PROF
First Name:NIKKI
Middle Name:R
Last Name:DEAS
Suffix:
Gender:F
Credentials:PA-3
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23515 HIGHWAY 190
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-7334
Mailing Address - Country:US
Mailing Address - Phone:985-624-4100
Mailing Address - Fax:985-624-4123
Practice Address - Street 1:23515 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-7334
Practice Address - Country:US
Practice Address - Phone:985-624-4100
Practice Address - Fax:985-624-4123
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide