Provider Demographics
NPI:1609275049
Name:MARTIN, NICKI DAWN (APRN,FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:NICKI
Middle Name:DAWN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN,FNP-BC
Other - Prefix:MRS
Other - First Name:NICKI
Other - Middle Name:DAWN
Other - Last Name:KIRBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN,FNP-BC
Mailing Address - Street 1:186 ELDER AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24739
Mailing Address - Country:US
Mailing Address - Phone:762-340-9353
Mailing Address - Fax:404-645-7572
Practice Address - Street 1:MED EXPRESS
Practice Address - Street 2:277 GREASY RIDGE RD
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740
Practice Address - Country:US
Practice Address - Phone:304-425-7615
Practice Address - Fax:304-425-7635
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN68714-FNP-BC363L00000X, 363LF0000X
VA0024172549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810028855Medicaid