Provider Demographics
NPI:1629309018
Name:DUKE, NIKITA N (CRNP)
Entity Type:Individual
Prefix:
First Name:NIKITA
Middle Name:N
Last Name:DUKE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 1ST AVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:COLLINWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:38450
Mailing Address - Country:US
Mailing Address - Phone:931-724-9000
Mailing Address - Fax:931-724-5577
Practice Address - Street 1:1351 TIE CAMP RD
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-2861
Practice Address - Country:US
Practice Address - Phone:931-253-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012363363L00000X
AL1-117650363L00000X
TN24063363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner