Provider Demographics
NPI:1609885854
Name:NISBET, NIKKEL D (DO)
Entity Type:Individual
Prefix:
First Name:NIKKEL
Middle Name:D
Last Name:NISBET
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-1837
Mailing Address - Country:US
Mailing Address - Phone:361-883-3032
Mailing Address - Fax:
Practice Address - Street 1:134 ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-1837
Practice Address - Country:US
Practice Address - Phone:361-883-3032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006016777207P00000X
TXN1021207P00000X
CA20A10106207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine